Today when presenting a patient to the attending physician, my intern tallied the number of times I said "um." I racked up a whopping 45 demerits. I understand that this may sound kind of nit-picky or perhaps mean if taken out of context. To clarify: I have a very good working relationship with this intern, and she's one of the nicer people I know. Also, she had warned me a few days ago that she would start doing this.
The idea is that I need to develop more fluidity in the way I communicate with my colleagues. Instead of saying "um," I should pause. Easier said than done. I've been saying "um" or some variant of it for my entire life! Moreover, almost everyone uses filler words in everyday speech. It's no small task to change this habit that's so deeply-ingrained not just personally but also culturally.
Still, it's good to be aware of this issue, and I'll of course give my best effort to minimize the number of times I use fillers when presenting a patient.
Wednesday, June 29, 2011
Third-year medical student as point of patient care
As I was presenting a patient to my resident, the nurse interrupted me to tell me that my patient's blood pressure was elevated. She then asked me what I wanted to do about it. She asked me. I was taken aback for a moment, looked at my resident, but he was looking right back at me waiting for an answer.
My answer: I thought that the high blood pressure was likely caused by pain and that we should just monitor her vitals and administer her regular blood pressure medications since her blood pressure had previously been well-controlled.
I looked back at my resident. Did I get the "correct" answer? He disagreed and recommended giving an extra medication to lower the patient's blood pressure immediately. Even though my recommendation didn't match my resident's, he did agree that my reasoning and recommendation were also valid.
What felt good, though, was that the nurse came to me with a question about my patient, not to my intern or resident. First, it tells me that I'm doing something right if the nurse perceived me as my patient's primary point of care. Second, it made me look good in front of my resident. I thanked the nurse for that, later.
My answer: I thought that the high blood pressure was likely caused by pain and that we should just monitor her vitals and administer her regular blood pressure medications since her blood pressure had previously been well-controlled.
I looked back at my resident. Did I get the "correct" answer? He disagreed and recommended giving an extra medication to lower the patient's blood pressure immediately. Even though my recommendation didn't match my resident's, he did agree that my reasoning and recommendation were also valid.
What felt good, though, was that the nurse came to me with a question about my patient, not to my intern or resident. First, it tells me that I'm doing something right if the nurse perceived me as my patient's primary point of care. Second, it made me look good in front of my resident. I thanked the nurse for that, later.
Sunday, June 26, 2011
Why I love working at PSL
First, the people: I really like my team. That can make or break an experience, as I've learned from talking with some of my classmates. More than that, though, as I observe the other Medicine teams at PSL, I haven't seen anyone about whom I thought, "Wow, I'm glad I'm not working with that person." Even the surgeon who we recently consulted for a patient was personable, enjoyed teaching me, and was interested in me as a person. When most people are like that here, it makes for a healthy and enjoyable environment.
Second, the food: All lunches are free. At first, I thought that lunches were just provided at noon conferences and lectures. Two noon lectures were canceled last week, and everyone still made their way downstairs for lunch. "You mean they give us lunch even when there isn't a lecture?" I had a hard time wrapping my mind around that idea. Also, my attending likes to invite her team to the doctor's cafeteria for breakfast on post-call mornings to talk about our patients. They also give us a stipend for the month for food at the cafeteria. Basically, I won't be going hungry on this rotation. Being well-fed is a big deal for a medical student.
I also enjoy being around my classmates and watching them go through the same process that I'm going through, which is something that I didn't get to experience during Adult Ambulatory and Rural Community Care.
I also love being able to ride my bike to work.
All in all, I'll be sad when my month here at PSL is over.
Second, the food: All lunches are free. At first, I thought that lunches were just provided at noon conferences and lectures. Two noon lectures were canceled last week, and everyone still made their way downstairs for lunch. "You mean they give us lunch even when there isn't a lecture?" I had a hard time wrapping my mind around that idea. Also, my attending likes to invite her team to the doctor's cafeteria for breakfast on post-call mornings to talk about our patients. They also give us a stipend for the month for food at the cafeteria. Basically, I won't be going hungry on this rotation. Being well-fed is a big deal for a medical student.
I also enjoy being around my classmates and watching them go through the same process that I'm going through, which is something that I didn't get to experience during Adult Ambulatory and Rural Community Care.
I also love being able to ride my bike to work.
All in all, I'll be sad when my month here at PSL is over.
Learning how to present a patient
Communicating with other doctors about a patient is a critical skill in medicine, one that is typically developed during the third and fourth years of medical school and honed during internship. The idea is to tell the patient's story in such a way that all relevant objective information is included, without editorializing, but the listener is able to form an idea in his or her mind the likely diagnosis and a list of other possible diagnoses.
It can be frustrating for medical students to develop this skill - it certainly has been frustrating for me. When I'm presenting a patient, I have the sense that my presentation is jumbled and inefficient, but I don't have a clear idea of how to improve it without losing the quality of information I'm trying to convey. Or, I know how I could improve the presentation but am not yet quick enough on my feet to do it on the spot.
I got two new patients yesterday while on call. I worked them up (which means interviewing them and doing a physical exam) and presented them to my intern. This first run-through was informal and messy but really served to help me organize my thoughts for when I would present to my resident.
My resident asked me to give a more formal presentation. These can be a little anxiety-provoking for me because it's a one-way communication rather than a conversation. I talk uninterrupted even if what's coming out of my mouth is pure garbage; if I pause to gather my thoughts, the person listening stays quiet rather than filling that pause with a question. Longer pauses can become very uncomfortable.
After finishing my presentation, my resident said, "Good! That was good. But let me tell you how you can make it better." We then went through my presentation section-by-section, highlighting ways in which I could better organize the information to tell a more clear story or present that information more concisely.
"Now present to me again." Really? Listening to a third-year medical student present a patient can be a painful experience. I've gotten plenty of feedback on my oral presentations in the past, but no one had ever asked me to present to them again immediately afterward.
So I presented to my resident a second time, and that presentation was much more organized. "Good! That was much better. But I'm going to show you how you can take it to the next level." We then went through my presentation a second time. He talked more about what the person listening to my presentation expects to hear, and when, in order to form a clear clinical picture in his or her mind. He also talked about how to more strategically present certain information, or leave out other information, in order to guide my listener along a particular line of thought.
"Now present to me again." Again? "Incredible!" I thought to myself as I prepared for the third presentation. This teaching process could have been intimidating if my resident were not so nice and laid-back.
One of my interns had been sitting nearby while this was all happening. When we finished, she came over to tell me how lucky I am: "What he's doing is amazing. No one ever did this for me, but I wish someone had."
I do realize how lucky I am that my resident took the time to teach me how to present a patient well. Not only that, but he did a really good job teaching me. First, let me make all my mistakes. Next, point out my mistakes and tell me how I can fix them. Next, let me try it again, hopefully making fewer mistakes than before. Then, repeat.
Before that session, I had felt like I was spinning my wheels in my efforts to improve my presentation skills. Now I feel that I have some traction.
It can be frustrating for medical students to develop this skill - it certainly has been frustrating for me. When I'm presenting a patient, I have the sense that my presentation is jumbled and inefficient, but I don't have a clear idea of how to improve it without losing the quality of information I'm trying to convey. Or, I know how I could improve the presentation but am not yet quick enough on my feet to do it on the spot.
I got two new patients yesterday while on call. I worked them up (which means interviewing them and doing a physical exam) and presented them to my intern. This first run-through was informal and messy but really served to help me organize my thoughts for when I would present to my resident.
My resident asked me to give a more formal presentation. These can be a little anxiety-provoking for me because it's a one-way communication rather than a conversation. I talk uninterrupted even if what's coming out of my mouth is pure garbage; if I pause to gather my thoughts, the person listening stays quiet rather than filling that pause with a question. Longer pauses can become very uncomfortable.
After finishing my presentation, my resident said, "Good! That was good. But let me tell you how you can make it better." We then went through my presentation section-by-section, highlighting ways in which I could better organize the information to tell a more clear story or present that information more concisely.
"Now present to me again." Really? Listening to a third-year medical student present a patient can be a painful experience. I've gotten plenty of feedback on my oral presentations in the past, but no one had ever asked me to present to them again immediately afterward.
So I presented to my resident a second time, and that presentation was much more organized. "Good! That was much better. But I'm going to show you how you can take it to the next level." We then went through my presentation a second time. He talked more about what the person listening to my presentation expects to hear, and when, in order to form a clear clinical picture in his or her mind. He also talked about how to more strategically present certain information, or leave out other information, in order to guide my listener along a particular line of thought.
"Now present to me again." Again? "Incredible!" I thought to myself as I prepared for the third presentation. This teaching process could have been intimidating if my resident were not so nice and laid-back.
One of my interns had been sitting nearby while this was all happening. When we finished, she came over to tell me how lucky I am: "What he's doing is amazing. No one ever did this for me, but I wish someone had."
I do realize how lucky I am that my resident took the time to teach me how to present a patient well. Not only that, but he did a really good job teaching me. First, let me make all my mistakes. Next, point out my mistakes and tell me how I can fix them. Next, let me try it again, hopefully making fewer mistakes than before. Then, repeat.
Before that session, I had felt like I was spinning my wheels in my efforts to improve my presentation skills. Now I feel that I have some traction.
Thursday, June 23, 2011
My first page
I got my first page this morning. It was from my resident:
"So, uh, are you bored?"
Somehow, I had imagined that my first page would be more emergent, or exciting, or at least more patient-oriented.
I'd been following one patient since this clerkship started on Monday, but the patient was discharged yesterday afternoon, which left me with no clinical duties. My resident felt bad, but there's nothing much he can do because our team of five is currently following only two patients total. That will change after tomorrow when we're on-call. Maybe I'll also get a "real" page that's actually about a patient!
"So, uh, are you bored?"
Somehow, I had imagined that my first page would be more emergent, or exciting, or at least more patient-oriented.
I'd been following one patient since this clerkship started on Monday, but the patient was discharged yesterday afternoon, which left me with no clinical duties. My resident felt bad, but there's nothing much he can do because our team of five is currently following only two patients total. That will change after tomorrow when we're on-call. Maybe I'll also get a "real" page that's actually about a patient!
Tuesday, June 21, 2011
The 60% rule
My chief resident told me today that he would rather I present 60% of a patient well than present 100% of a patient poorly. Quality over quantity, with an emphasis on being concise. Presenting a patient is difficult skill master in part because it requires judgment as to what information to include or exclude. For example, when presenting a patient with congestive heart failure, my resident doesn't want to hear me describe a normal eye exam. I'm fortunate in that my intern and resident are both very understanding and helpful in my efforts to develop this skill.
Monday, June 20, 2011
A note about HIPAA
After sharing this blog with some interns, the leaders of my "hidden curriculum" group, they talked with me about patient privacy concerns. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) outlines regulations for the handling of patient information, and they wanted to be sure that I was not violating this law in discussing patients on this blog. I appreciate that they came to me with their concern, both in protecting my patients from possible breach of confidentiality and in protecting me from my own possible ignorance of the regulations.
However, I am well aware of HIPAA regulations. When discussing patients on this blog, I am very careful about omitting potential identifying information including age and race. I also randomly change the gender of my patients when I have to use pronouns. My policy is to err on the side of caution and to seek advice from a classmate or a supervisor whenever I have questions about the appropriateness of discussing any topic (for example, conflict between a nurse and an attending physician).
After reviewing all of my patient-centered blog posts, I am comfortable that I appropriately protected my patients' confidentiality. That said, though, if any of my readers are ever uncomfortable about the inclusion of particular information as it relates to patient confidentiality, I encourage them to contact me so I can edit the post as quickly as possible.
However, I am well aware of HIPAA regulations. When discussing patients on this blog, I am very careful about omitting potential identifying information including age and race. I also randomly change the gender of my patients when I have to use pronouns. My policy is to err on the side of caution and to seek advice from a classmate or a supervisor whenever I have questions about the appropriateness of discussing any topic (for example, conflict between a nurse and an attending physician).
After reviewing all of my patient-centered blog posts, I am comfortable that I appropriately protected my patients' confidentiality. That said, though, if any of my readers are ever uncomfortable about the inclusion of particular information as it relates to patient confidentiality, I encourage them to contact me so I can edit the post as quickly as possible.
My first day on Hospitalized Adult Care clerkship
Overall, I think today was a good day.
Orientations
My day started off with the clerkship orientation at the University. Most orientations tend to be rather tedious, but the HAC block director livened up her presentation. For example, she interrupted her presentation periodically to ask us trivia questions and threw a piece of candy to the person who answered it first. I got some rice crispy treats for identifying Dr. Leonard McCoy. Another example: she talked extensively about double-plays and triple-plays in baseball as an analogy for the management of patient care as a patient is discharged from the hospital. This was an unexpectedly fun way to start a clerkship with a solid reputation for being difficult and stressful.
I also had a site-specific orientation at Presbyterian Saint Luke's (PSL) hospital, first with the chief medical resident and second with the site director. These orientations were a bit more down-to-business, but both the chief resident and the site director seem very nice and approachable.
We got yet another ID badge, and we got some pizza at the noon conference on pathology. The basic format was the pathologist showing pathology slides ordered by the residents and interns; when he pulled up slides from a new patient, the intern or resident caring for the patient gave a brief clinical history before the pathologist continued. It was very interesting, but I have to admit that I didn't learn too much pathology during that session because I wasn't personally familiar with any of the patients.
Afterward, I finally got to meet my team, all of whom are very nice and seem eager to help me learn. It turns out, though, that I'm starting my HAC clerkship at a time of transition. The intern with whom I was working today will be leaving in two days to become a first-year resident, and a freshly-graduated medical student will take her place.
On call
It turns out that I am on call today on the first day of my HAC clerkship. What does it mean to be on call? The short answer is that my team admits new patients, and we will care for all of those new admits. I am on-call every fourth night. If we don't admit many patients, then the next few days will be relatively quiet. Third-year medical students are required to stay until midnight when on-call, while the interns and residents stay overnight. On post-call days, third-year medical students are generally sent home early after we have completed our clinical duties.
My first impression of being on call was watching the Travel Channel with the team. Apparently, today is a very slow day. They said that for some reason the Summer months are typically slow. This was a good way to get to know the team, even though it did feel weird to be watching TV in the middle of the day.
I did finally get one patient, but this was an atypical patient in that he was being admitted from another department and had already been "worked up." This meant that he had already been diagnosed and treated and that we were just providing follow-up care. My resident had me see the patient anyways, so I took it as an opportunity to practice my History and Physical and my oral presentation. I'm actually glad that it worked out this way, because having zero experience, it takes me a very long time to do a H&P that would take a resident 20 minutes max.
Hidden curriculum versus on-call?
One wrench that was thrown into my day was a meeting with my old problem-based learning (PBL) group from the first two years to talk about the so-called "hidden curriculum." I'll save a discussion of that for later, but my conflict was: Should I go to this hidden curriculum meeting or stay at the hospital since I'm on-call? Both the block director and the site director told me to go to the hidden curriculum meeting, so I went.
But that didn't keep me from feeling like I was making a poor first impression when I told my resident that I was leaving for a few hours. He told me that I didn't need to come back to the hospital afterward since it was a slow night and I could just pick up a patient tomorrow morning. This just didn't feel right to me.
This meeting is run by two new interns. Both of these interns just graduated from CU Denver, and I know one of them from before. As fortune would have it, the second intern will be on my medicine team starting in two days! I told my group leaders that I was on call tonight and what had happened with my resident; they both recommended that I check back in with him before going home.
So after the hidden curriculum meeting, I headed back to PSL and paged my resident. "I know you told me that I didn't have to come back in tonight, but I thought I would check back in to see whether we got any new patients that I could take on." He was surprised when I told him that I was back at the hospital. We didn't have any new patients, but he said that we could go over the H&P that I prepared for our patient from earlier in the afternoon.
This turned out to be super-helpful, especially because at this point I feel like I still have so much more room for improvement in both the H&P and the oral presentation. I got positive feedback on certain aspects of the presentation and helpful criticisms on others. Most importantly, though, I feel that I righted what could have been a poor first impression. After presenting the H&P, my resident more forcefully sent me home early.
Some reflection
Taking a step back, I recognize that I have a relatively high level of anxiety about how I am perceived by my team and by my ability to perform at an education-appropriate level. But I think that this anxiety is normal and helps me to more quickly adapt to my new learning environment. At some point, I will be writing specifically about transitions between clerkships as a third-year medical student.
For now, though, I'm going to spend my energies acclimating to life on the internal medicine service at PSL.
Orientations
My day started off with the clerkship orientation at the University. Most orientations tend to be rather tedious, but the HAC block director livened up her presentation. For example, she interrupted her presentation periodically to ask us trivia questions and threw a piece of candy to the person who answered it first. I got some rice crispy treats for identifying Dr. Leonard McCoy. Another example: she talked extensively about double-plays and triple-plays in baseball as an analogy for the management of patient care as a patient is discharged from the hospital. This was an unexpectedly fun way to start a clerkship with a solid reputation for being difficult and stressful.
I also had a site-specific orientation at Presbyterian Saint Luke's (PSL) hospital, first with the chief medical resident and second with the site director. These orientations were a bit more down-to-business, but both the chief resident and the site director seem very nice and approachable.
We got yet another ID badge, and we got some pizza at the noon conference on pathology. The basic format was the pathologist showing pathology slides ordered by the residents and interns; when he pulled up slides from a new patient, the intern or resident caring for the patient gave a brief clinical history before the pathologist continued. It was very interesting, but I have to admit that I didn't learn too much pathology during that session because I wasn't personally familiar with any of the patients.
Afterward, I finally got to meet my team, all of whom are very nice and seem eager to help me learn. It turns out, though, that I'm starting my HAC clerkship at a time of transition. The intern with whom I was working today will be leaving in two days to become a first-year resident, and a freshly-graduated medical student will take her place.
On call
It turns out that I am on call today on the first day of my HAC clerkship. What does it mean to be on call? The short answer is that my team admits new patients, and we will care for all of those new admits. I am on-call every fourth night. If we don't admit many patients, then the next few days will be relatively quiet. Third-year medical students are required to stay until midnight when on-call, while the interns and residents stay overnight. On post-call days, third-year medical students are generally sent home early after we have completed our clinical duties.
My first impression of being on call was watching the Travel Channel with the team. Apparently, today is a very slow day. They said that for some reason the Summer months are typically slow. This was a good way to get to know the team, even though it did feel weird to be watching TV in the middle of the day.
I did finally get one patient, but this was an atypical patient in that he was being admitted from another department and had already been "worked up." This meant that he had already been diagnosed and treated and that we were just providing follow-up care. My resident had me see the patient anyways, so I took it as an opportunity to practice my History and Physical and my oral presentation. I'm actually glad that it worked out this way, because having zero experience, it takes me a very long time to do a H&P that would take a resident 20 minutes max.
Hidden curriculum versus on-call?
One wrench that was thrown into my day was a meeting with my old problem-based learning (PBL) group from the first two years to talk about the so-called "hidden curriculum." I'll save a discussion of that for later, but my conflict was: Should I go to this hidden curriculum meeting or stay at the hospital since I'm on-call? Both the block director and the site director told me to go to the hidden curriculum meeting, so I went.
But that didn't keep me from feeling like I was making a poor first impression when I told my resident that I was leaving for a few hours. He told me that I didn't need to come back to the hospital afterward since it was a slow night and I could just pick up a patient tomorrow morning. This just didn't feel right to me.
This meeting is run by two new interns. Both of these interns just graduated from CU Denver, and I know one of them from before. As fortune would have it, the second intern will be on my medicine team starting in two days! I told my group leaders that I was on call tonight and what had happened with my resident; they both recommended that I check back in with him before going home.
So after the hidden curriculum meeting, I headed back to PSL and paged my resident. "I know you told me that I didn't have to come back in tonight, but I thought I would check back in to see whether we got any new patients that I could take on." He was surprised when I told him that I was back at the hospital. We didn't have any new patients, but he said that we could go over the H&P that I prepared for our patient from earlier in the afternoon.
This turned out to be super-helpful, especially because at this point I feel like I still have so much more room for improvement in both the H&P and the oral presentation. I got positive feedback on certain aspects of the presentation and helpful criticisms on others. Most importantly, though, I feel that I righted what could have been a poor first impression. After presenting the H&P, my resident more forcefully sent me home early.
Some reflection
Taking a step back, I recognize that I have a relatively high level of anxiety about how I am perceived by my team and by my ability to perform at an education-appropriate level. But I think that this anxiety is normal and helps me to more quickly adapt to my new learning environment. At some point, I will be writing specifically about transitions between clerkships as a third-year medical student.
For now, though, I'm going to spend my energies acclimating to life on the internal medicine service at PSL.
Friday, June 17, 2011
Preparing for my Hospitalized Adult Care clerkship
My Hospitalized Adult Care (HAC) clerkship starts on Monday. I will be spending the first month at Presbyterian Saint Luke's and the second month at Denver Health.
Whereas during my Adult Ambulatory Care and Rural Community Care clerkships I was essentially working one-on-one with a primary care doctor, I will now be working as part of a team. At PSL, the Internal Medicine department has four separate teams, which means that I'll be working alongside three of my classmates, each one of us on a different team. For the first two weeks at PSL, I'll also have a sub-intern (i.e. a fourth-year medical student) on my team, which I'm happy about since he could provide one more layer of mentorship. The team also includes two interns, a resident, and of course an attending physician; the latter two will rotate out halfway through my clerkship.
I bought two textbooks for this rotation: Internal Medicine Essentials for Clerkship Students 2 and Medical Knowledge Self-Assessment Program for Students 4. IMECS is a true textbook, while MKSAP provides clinically-based questions that are meant to be completed alongside the text. Having read the table of contents and flipped through both of them briefly, they look like they will be very useful. The IMECS chapters are short enough that I could easily knock one off just by reading 15 minutes here or there when I have some free time.
As for now, though, I'm trying to squeeze as much relaxation as possible out of this weekend since I don't expect to have much time for such luxury once HAC begins.
Whereas during my Adult Ambulatory Care and Rural Community Care clerkships I was essentially working one-on-one with a primary care doctor, I will now be working as part of a team. At PSL, the Internal Medicine department has four separate teams, which means that I'll be working alongside three of my classmates, each one of us on a different team. For the first two weeks at PSL, I'll also have a sub-intern (i.e. a fourth-year medical student) on my team, which I'm happy about since he could provide one more layer of mentorship. The team also includes two interns, a resident, and of course an attending physician; the latter two will rotate out halfway through my clerkship.
I bought two textbooks for this rotation: Internal Medicine Essentials for Clerkship Students 2 and Medical Knowledge Self-Assessment Program for Students 4. IMECS is a true textbook, while MKSAP provides clinically-based questions that are meant to be completed alongside the text. Having read the table of contents and flipped through both of them briefly, they look like they will be very useful. The IMECS chapters are short enough that I could easily knock one off just by reading 15 minutes here or there when I have some free time.
As for now, though, I'm trying to squeeze as much relaxation as possible out of this weekend since I don't expect to have much time for such luxury once HAC begins.
Thursday, June 9, 2011
The rural routine
As I'm wrapping up my rural rotation, I think it's worth noting what my routine has been like for these four weeks. On weekdays (except Thursdays, which I have off):
I show up at Timberline Family Practice at 8am. From 8:00-8:30, I either discuss patients or learning objectives with my preceptor, or I read my textbook Essentials of Family Medicine. I see around 6-8 patients from 8:30am-1:00pm. Most of the patients I first see on my own, present them to my preceptor, then finish them together with my preceptor. Some patients I see with my preceptor from the beginning, either observing him or having him observe me.
Lunch break is from 1:00-2:00pm.
In the afternoon, I see around 4-6 patients from 2:00-5:00pm. Then I go for a run or otherwise relax, and I do a little more textbook reading before bed.
I'm keenly aware of how luxurious this schedule is. Once I start my Internal Medicine (Hospitalized Adult Care) rotation, I expect to be working around 12-16 hours per day, 6 days per week.
I show up at Timberline Family Practice at 8am. From 8:00-8:30, I either discuss patients or learning objectives with my preceptor, or I read my textbook Essentials of Family Medicine. I see around 6-8 patients from 8:30am-1:00pm. Most of the patients I first see on my own, present them to my preceptor, then finish them together with my preceptor. Some patients I see with my preceptor from the beginning, either observing him or having him observe me.
Lunch break is from 1:00-2:00pm.
In the afternoon, I see around 4-6 patients from 2:00-5:00pm. Then I go for a run or otherwise relax, and I do a little more textbook reading before bed.
I'm keenly aware of how luxurious this schedule is. Once I start my Internal Medicine (Hospitalized Adult Care) rotation, I expect to be working around 12-16 hours per day, 6 days per week.
Monday, June 6, 2011
There's a bug going around Granby
I spent the past weekend holed up in my apartment above the garage sick with a low-grade fever and a sore throat. I also saw a bunch of patients last week who had the same symptoms, so it's not too surprising that I got sick. This is one of the perks of being a primary care doctor.
Although, I asked my preceptor how often he gets sick; he said just once a year or so, suggesting that he tends not to catch bugs from his patients. That may be because over the years he's built up an immunity to most of the bacteria and viruses circulating through the community. The thought also occurred to me that the technique he uses when looking in the nose and throat of patients saves him from the kind of over-exposure that you might think he would get. I'm trying to pick up as much as that technique as I can.
Lucky for me, none of my patients last week tested positive for Strep throat, and all of them had been sick for less than a week.
Although, I asked my preceptor how often he gets sick; he said just once a year or so, suggesting that he tends not to catch bugs from his patients. That may be because over the years he's built up an immunity to most of the bacteria and viruses circulating through the community. The thought also occurred to me that the technique he uses when looking in the nose and throat of patients saves him from the kind of over-exposure that you might think he would get. I'm trying to pick up as much as that technique as I can.
Lucky for me, none of my patients last week tested positive for Strep throat, and all of them had been sick for less than a week.
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