So far my first week in Urgent Care is going pretty well. I would have liked more procedures, but I did get to remove some stitches and help remove a FB (foreign body) from a guy's eye.
The docs that work there are more laid back than I expected. They really like their freetime and typically only work about 32 hours a week, with no call, swing shift or the stress of the ER.
They are also pretty knowledgeable about medicine. I'm getting MUCH better at my charting and learning a fair amount along the way. Once I get done reading Problem-based Microbiology (a great book!) I need to focus more on the medicine: start reading Step-up to Medicine and watching the Kaplan Step 2 videos again. However, all of this is slightly delayed now that the boys and I just purchased a used Xbox 360. The newness of it will wear off on me, but I need to give a few days.
Until then, I'm going to be working through a nasty viral URI and seeing tons of patients in a great setting for learning.
Thursday, August 31, 2006
Saturday, August 26, 2006
Mountains Beyond Mountains
The couple of weeks I've had some free time. So I watched the 2nd season of Sopranos (terrific) and read some. After finishing Hostile Takeover and a bunch of magazines, I read Tracy Kidder's Mountains Beyond Mountains.
It's a fantastic book with great prose and an in depth study into a fascinating character. Paul Farmer is a Harvard MD who has battled TB in Haiti and Peru for most of his life. He is brilliant and willing to endure a lifestyle most people would call torture, but he's been very effective.
It has added even more appeal to running my own rural practice. Becky and I are now seriously considering staying in Phoenix for residency then heading to the Northwest after Connor graduates from High School. If she gets a promotion as has been discussed it will be even more appealing. I'll have one extra year to start practicing after residency or to finish a fellowship. Scottsdale Healthcare seems to have the best program, but I can't rotate there until 4th year. So for now, I'm putting out feelers and doing as much research as I can online.
The biggest obstacle is that Colton, Mr. Social, would have to move from a suburban High School before Junior year to a rural one. He wouldn't have his brother around, and I'd be pretty busy trying to start my practice or get a handle on one I purchase.
To hedge my bets, I'd like to learn procedures that are useful in both suburban and rural areas like OMM and Derm. GI and OB stuff are probably more suited to rural areas due to insurance and malpractice risk. Well plenty of time to make those decisions. But not too soon to plan my last elective rotation of this year and start thinking of my MSIV schedule. In fact, I should check how soon I can schedule an audition rotation at Scottsdale Healthcare.
The two most inspirational medical books I've read are outstanding character studies about two of the most obsessed physicians ever. Robert Mee, a pediatric thoracic surgeon at the Cleveland Clinic and Paul Farmer, an infectious disease IM physician at Harvard and Haiti. It's good for us students to have some heroes.
It's a fantastic book with great prose and an in depth study into a fascinating character. Paul Farmer is a Harvard MD who has battled TB in Haiti and Peru for most of his life. He is brilliant and willing to endure a lifestyle most people would call torture, but he's been very effective.
It has added even more appeal to running my own rural practice. Becky and I are now seriously considering staying in Phoenix for residency then heading to the Northwest after Connor graduates from High School. If she gets a promotion as has been discussed it will be even more appealing. I'll have one extra year to start practicing after residency or to finish a fellowship. Scottsdale Healthcare seems to have the best program, but I can't rotate there until 4th year. So for now, I'm putting out feelers and doing as much research as I can online.
The biggest obstacle is that Colton, Mr. Social, would have to move from a suburban High School before Junior year to a rural one. He wouldn't have his brother around, and I'd be pretty busy trying to start my practice or get a handle on one I purchase.
To hedge my bets, I'd like to learn procedures that are useful in both suburban and rural areas like OMM and Derm. GI and OB stuff are probably more suited to rural areas due to insurance and malpractice risk. Well plenty of time to make those decisions. But not too soon to plan my last elective rotation of this year and start thinking of my MSIV schedule. In fact, I should check how soon I can schedule an audition rotation at Scottsdale Healthcare.
The two most inspirational medical books I've read are outstanding character studies about two of the most obsessed physicians ever. Robert Mee, a pediatric thoracic surgeon at the Cleveland Clinic and Paul Farmer, an infectious disease IM physician at Harvard and Haiti. It's good for us students to have some heroes.
Finished second rotation
Yesterday was my last day with Dr. Will for my Family Practice/OMM rotation. The last two weeks I don't think the learning curve was quite as steep, but I honed some skills and really enjoyed getting to know patients.
The last two days were some of the most interesting medically. Thursday, on FP, I saw one of the worst movement disorders any of the physicians had ever seen. Worse, the patient's vocal cords were spasming making her voice and expressions look like something from the Poltergiest. She was nice, but a very complicated case. She'd had these symptoms for a year and a half with only Demerol (huge amounts!) for relief since she was allergic to 32 drugs! Plus she already on 15 for a dozen or so medical conditions like hypothyroidism, IBS, CAD, severe L3-L5 DJD, spondolysthesis, etc, Her husband was a perfect presentation of clinical depression. He obviously had no life other than treating his invalid wife.
It was my first time on rotation actually thinking if I could live in her condition. I can't imagine doing nothing about it for a year and a half. It almost seemed like she was trying to slowly do herself in with huge amounts of Demerol.
Friday at Dr. Will's OMM practice we saw two Arnold-Chiari cases! Both women had serious operations for spinal cord compression, but both were otherwise perfectly normal. Not at all like the Pathology slides I remember describing all the associated neurological conditions.
My review was excellent and I gave Dr. Will equally high marks. He really reminded me how FP can be noble as well as rewarding and fun. I don't expect next months' Urgent Care rotation will seem as attractive, but I hope I will have a chance to do more procedures and hone my patient charting.
Finally, I had a nice conversation with our Clinical Education Dept. Instead of scheduling my rural rotation later this year as an IM rotation like I had planned, I signed up for a rural FP rotation in Snowflake, AZ. It's supposed to be a great rotation with lots of patients, pathology and procedures (my "three P's"). Becky and I even bumped into a classmate at Costco who just finished the rotation yesterday. He spoke very highly of it. Sounds like a beautiful area only four hours away.
The last two days were some of the most interesting medically. Thursday, on FP, I saw one of the worst movement disorders any of the physicians had ever seen. Worse, the patient's vocal cords were spasming making her voice and expressions look like something from the Poltergiest. She was nice, but a very complicated case. She'd had these symptoms for a year and a half with only Demerol (huge amounts!) for relief since she was allergic to 32 drugs! Plus she already on 15 for a dozen or so medical conditions like hypothyroidism, IBS, CAD, severe L3-L5 DJD, spondolysthesis, etc, Her husband was a perfect presentation of clinical depression. He obviously had no life other than treating his invalid wife.
It was my first time on rotation actually thinking if I could live in her condition. I can't imagine doing nothing about it for a year and a half. It almost seemed like she was trying to slowly do herself in with huge amounts of Demerol.
Friday at Dr. Will's OMM practice we saw two Arnold-Chiari cases! Both women had serious operations for spinal cord compression, but both were otherwise perfectly normal. Not at all like the Pathology slides I remember describing all the associated neurological conditions.
My review was excellent and I gave Dr. Will equally high marks. He really reminded me how FP can be noble as well as rewarding and fun. I don't expect next months' Urgent Care rotation will seem as attractive, but I hope I will have a chance to do more procedures and hone my patient charting.
Finally, I had a nice conversation with our Clinical Education Dept. Instead of scheduling my rural rotation later this year as an IM rotation like I had planned, I signed up for a rural FP rotation in Snowflake, AZ. It's supposed to be a great rotation with lots of patients, pathology and procedures (my "three P's"). Becky and I even bumped into a classmate at Costco who just finished the rotation yesterday. He spoke very highly of it. Sounds like a beautiful area only four hours away.
Sunday, August 13, 2006
Dad's B-day
Last week ended well. Nothing major at the clinic, but I'm slowly gaining confidence with patients and learning how to treat patients with basic OMM solutions. If I go the FP route, OMM is looking more interesting than the OB fellowship at the moment. It's fun, but we'll see how I fell after getting back in the OR.
Becky had a good week. She learned that she is going to be groomed to be next in line at her work to run the place. While nothing is for certain, it is pretty exciting. I started asking around about FP residencies in the area and got a few ideas that I shared with Becky. We may just end up staying here for another 5+ years. That would be a surprise. But I think Becky would enjoy finally getting her chance to be called President :-).
This weekend, the family went to San Diego to see my father. It was the first time I've seen him since his stroke over three months ago. He is doing pretty well. His right hand is functional for only the most basic tasks, but he walks with very little limp and his face and voice are just about back to normal. Recover is slowing down which is hard on him I think. But he enjoyed seeing the boys for his 64th B-day.
My concern isn't so much about the stroke, but his underlying mycosis fungoides. It's not clear that his radiation treatment (TBI) really put it into remission. I don't know if his immune system is back to 100% after the stroke. It's frustrating not being able to do anything or have any ideas.
Being my first time back to S.D. since MSII started I also got to see the low-milage car he purchased eight months ago, an Infiniti G35. It was a blast to drive and is my favorite car at the moment. A very reasonably priced luxury car and a respectable doctor's car!
Going to be a busy week with the boys starting 3rd and 6th Grades tomorrow, so it's time to get some rest.
Becky had a good week. She learned that she is going to be groomed to be next in line at her work to run the place. While nothing is for certain, it is pretty exciting. I started asking around about FP residencies in the area and got a few ideas that I shared with Becky. We may just end up staying here for another 5+ years. That would be a surprise. But I think Becky would enjoy finally getting her chance to be called President :-).
This weekend, the family went to San Diego to see my father. It was the first time I've seen him since his stroke over three months ago. He is doing pretty well. His right hand is functional for only the most basic tasks, but he walks with very little limp and his face and voice are just about back to normal. Recover is slowing down which is hard on him I think. But he enjoyed seeing the boys for his 64th B-day.
My concern isn't so much about the stroke, but his underlying mycosis fungoides. It's not clear that his radiation treatment (TBI) really put it into remission. I don't know if his immune system is back to 100% after the stroke. It's frustrating not being able to do anything or have any ideas.
Being my first time back to S.D. since MSII started I also got to see the low-milage car he purchased eight months ago, an Infiniti G35. It was a blast to drive and is my favorite car at the moment. A very reasonably priced luxury car and a respectable doctor's car!
Going to be a busy week with the boys starting 3rd and 6th Grades tomorrow, so it's time to get some rest.
Tuesday, August 08, 2006
Family Practice routine
Life is pretty comfortable in this rotation. I work my hours, do a little reading at lunch and/or the evening. I go in an interview patients. Then I either discuss diagnosis and treatment (FP days) or start team manipulation (OMM days) with Dr. Will. I'm getting decent at charting and scripting and my OMM skills are definitely improving.
The rural family guy life is looking more and more attractive. It's not as prestigious or high paying as the more specialized or academic practices. But the freedom, hours, lifestyle and potential for procedures (especially in a rural town) sure sound better than struggling to get a competitive residency in some grimy East Coast town, working long hours for many years, then moving the family again to some expensive West Coast city where even a Doc's salary barely pays the mortgage. And then you have to deal with bureaucrats in the hospital or soap operas in partnerships.
It's probably time to dive into FP residency research. I also need to install Google Maps and do some fly-bys of Northwest rural areas and start to get some ideas of where the family would be happy.
Oh, the weekend was fun. Saturday I mowed, edged, pooper-scooped and blew the yard in 110 degree heat. After collapsing I relaxed most of the day until it was time to go see the Diamondbacks get spanked by the Astros (9-3). Clemens is still dangerous. It was an ok date night, but the sushi at Ra was horrible. We heard reviews that it was the best in Phoenix, but I thought it was slightly better than Costco!
Sunday we had Tucker and his family over for some 'real' salmon; King salmon caught wild. It was delicious - the tastiest fish in the world IMHO. And a far cry from the over-priced, dyed, farm salmon advertised as 'top shelf Atlantic salmon'. Yuck. Tucker and I also had some time to discuss residencies and practices in the Northwest. It was great to see his family, have great food and wine and then knock around ideas about the next five or so years with a fellow student.
The rural family guy life is looking more and more attractive. It's not as prestigious or high paying as the more specialized or academic practices. But the freedom, hours, lifestyle and potential for procedures (especially in a rural town) sure sound better than struggling to get a competitive residency in some grimy East Coast town, working long hours for many years, then moving the family again to some expensive West Coast city where even a Doc's salary barely pays the mortgage. And then you have to deal with bureaucrats in the hospital or soap operas in partnerships.
It's probably time to dive into FP residency research. I also need to install Google Maps and do some fly-bys of Northwest rural areas and start to get some ideas of where the family would be happy.
Oh, the weekend was fun. Saturday I mowed, edged, pooper-scooped and blew the yard in 110 degree heat. After collapsing I relaxed most of the day until it was time to go see the Diamondbacks get spanked by the Astros (9-3). Clemens is still dangerous. It was an ok date night, but the sushi at Ra was horrible. We heard reviews that it was the best in Phoenix, but I thought it was slightly better than Costco!
Sunday we had Tucker and his family over for some 'real' salmon; King salmon caught wild. It was delicious - the tastiest fish in the world IMHO. And a far cry from the over-priced, dyed, farm salmon advertised as 'top shelf Atlantic salmon'. Yuck. Tucker and I also had some time to discuss residencies and practices in the Northwest. It was great to see his family, have great food and wine and then knock around ideas about the next five or so years with a fellow student.
Friday, August 04, 2006
First Week of Family
Like I said yesterday, Family is looking pretty good. And if you keep up the OMM, you can always build up your patient base to do OMM full-time and increase your income $20-$50k per year from reduced insurance and overhead. In a rural environment, that wouldn't be too shabby. I could even take two hour lunches to get in a good swim or bike workout if there's no hospital bureaucrat babysitting.
Oh, got do to my first nerve block today. Injected some anesthetic into a patient's SI joint. Other than that, it was Fibromyalgia day. Lots of soft tissue OMM with myofascial release and counterstrain. Like asthma, there's a huge variation in severity, so some patients winced at the lightest touch while others handled muscle energy without any complaints. As you'd expect, these patients were using a fair amount of psychiatry drugs, so it was a little review from my last rotation.
Another weekend of chores, playing with the kids and cleaning up - but no studying for a Monday morning test!
Oh, got do to my first nerve block today. Injected some anesthetic into a patient's SI joint. Other than that, it was Fibromyalgia day. Lots of soft tissue OMM with myofascial release and counterstrain. Like asthma, there's a huge variation in severity, so some patients winced at the lightest touch while others handled muscle energy without any complaints. As you'd expect, these patients were using a fair amount of psychiatry drugs, so it was a little review from my last rotation.
Another weekend of chores, playing with the kids and cleaning up - but no studying for a Monday morning test!
Thursday, August 03, 2006
Day four and Family looks pretty good
It's weird, but I'm really starting to enjoy the pace of Family Practice. Maybe it's the way Dr. Will runs his practice, but it doesn't feel like the treadmill I've seen from preceptors in the past. There's little rushing around, and the OMM days are a great break from medicine; you get to work with your hands on patients over 30 minutes so it's very relaxing. And frequently it's very rewarding. I've seen patients come back with long-lasting improvement after no benefit from chiropractors, orthopods or pain management folks.
We are even getting MD residents from Mayo and Good Sam that will be training at the clinic for 6 months. The result with be more acceptance of manual medicine in the Allopathic world and more rotations for us at those institutions.
Today I also had a chance to treat one of our science professors. It was a little weird and really reminded me to pay attention to patient privacy.
Finally, I'm starting to feel more like a doc all the time. I'm going in and working up patients myself, charting them and then writing up the scripts. I'm learning a lot but more importantly, I'm getting comfortable with the role as the Doc.
We are even getting MD residents from Mayo and Good Sam that will be training at the clinic for 6 months. The result with be more acceptance of manual medicine in the Allopathic world and more rotations for us at those institutions.
Today I also had a chance to treat one of our science professors. It was a little weird and really reminded me to pay attention to patient privacy.
Finally, I'm starting to feel more like a doc all the time. I'm going in and working up patients myself, charting them and then writing up the scripts. I'm learning a lot but more importantly, I'm getting comfortable with the role as the Doc.
Wednesday, August 02, 2006
Starting OMM
Day 1
Monday my Preceptor spends at the campus clinic doing OMM. So I got to shake off the rust and do some muscle energy, counterstrain and myofascial release techniques. I even hit a couple HVLAs on the first try! It was fun and Dr. Will seemed very willing to let me talk to patients alone, chart stuff, do OMM, etc. It looks like I'll be doing injections soon for nerve blocks.
The only downside to the day was auto repairs. New minivan tires and our new 'pre-owned' Sante Fe had blown a timing belt. I even enjoyed having a homework assignment to read up on Fibromyalgia, which is about 20% of Dr. Will's OMM patients. I had absolutely zero stress about the next day's Psychiatry shelf exam which was a nice change. Gotta love Pass-Fail.
Day 2
Tuesday I had large and small group didactic group lectures in the morning. It was really nice to see many of my classmates again and catch-up on everyone's first rotation. I was also surprised by some USMLE scores. A few people scored really high like Tucker, but many scored below my expectations. At lunch I finally did a little studying for the Psych test, but I relied on my drug charts and FirstAid for Psychiatry totally. I just don't like our Prof's notes at all. I think I did very well on the test. It was even easier than already low expectations.
After biting the bullet on the car and agreeing to $1300 for the timing belt and related damage, I headed to the clinic. On Tuesdays, Dr. Will works on the family practice side of the clinic. I made it in time to see a few patients myself and practice some physical exam skills (shaking off more rust). I hope I can do whole physicals and blood draws soon, but I got a taste of it. Tonight's homework was Metabolic Syndrome and I was pleasantly surprised to find the best info on it in my PDA version of Ferri's Guide, not Harrison's, Robbin's or Netter's.
Monday my Preceptor spends at the campus clinic doing OMM. So I got to shake off the rust and do some muscle energy, counterstrain and myofascial release techniques. I even hit a couple HVLAs on the first try! It was fun and Dr. Will seemed very willing to let me talk to patients alone, chart stuff, do OMM, etc. It looks like I'll be doing injections soon for nerve blocks.
The only downside to the day was auto repairs. New minivan tires and our new 'pre-owned' Sante Fe had blown a timing belt. I even enjoyed having a homework assignment to read up on Fibromyalgia, which is about 20% of Dr. Will's OMM patients. I had absolutely zero stress about the next day's Psychiatry shelf exam which was a nice change. Gotta love Pass-Fail.
Day 2
Tuesday I had large and small group didactic group lectures in the morning. It was really nice to see many of my classmates again and catch-up on everyone's first rotation. I was also surprised by some USMLE scores. A few people scored really high like Tucker, but many scored below my expectations. At lunch I finally did a little studying for the Psych test, but I relied on my drug charts and FirstAid for Psychiatry totally. I just don't like our Prof's notes at all. I think I did very well on the test. It was even easier than already low expectations.
After biting the bullet on the car and agreeing to $1300 for the timing belt and related damage, I headed to the clinic. On Tuesdays, Dr. Will works on the family practice side of the clinic. I made it in time to see a few patients myself and practice some physical exam skills (shaking off more rust). I hope I can do whole physicals and blood draws soon, but I got a taste of it. Tonight's homework was Metabolic Syndrome and I was pleasantly surprised to find the best info on it in my PDA version of Ferri's Guide, not Harrison's, Robbin's or Netter's.
Back to Arizona
Colton's Party on Saturday was fun. We had a bigger group of relatives than I expected, and it made for a really fun day. I also had the chance to share of a little of my 'front line' experience with a cousin starting med school this year at the UW. Of course Colton got way more cash than any child should have, but what do you give a boy with everything (except that Xbox 360 we are making them save up for).
After everyone left, it was time to pack up for the trip back. Becky, Julie and the boys headed back early the next morning. I flew back in the afternoon to arrive in time to prepare for new rotation starting at 8am Monday morning. It ended up that the boys were a handful and the women decided to pull an all nighter anyway, but I did sleep better in my bed than I would have in the back of the van.
My flight was fine. I purchased a book called Hostile Takeover I heard about on NPR that is taking me further left and more in the middle than ever before. The book makes some well documented points that being fiscally conservative today is as much anti-Republican (i.e. anti-Big Business) as anti-Democrat. It highlighted three disappointments:
1) Bush has betrayed the Reagan Republicans and squandered his legacy
2) Bush has given in to Big Business more than anyone in recent memory, at great cost to Americans freedom, privacy, financial and military security
3) What the heck happened to the Contract With America?
Anyway, I certainly don't trust the Demos more. Giving in to the NEA, labor and big, centralized government is no better. Time to get off the soapbox...
I met an incredibly interesting Doc on the flight back. He was an Air Force fighter pilot for 23 years, got his MBA, started Med School and 48, then went on to get Boarded in IM and EM! He's 68 and working 24x7 (8 days off in the last year!) as the only physician in a rural 16 bed hospital. The nearest Doc is 120 miles away! He's done a ton of interesting procedures and is making a bundle. Not only does he have incredible energy for a 68 yo, he said that if he knew his hands would still be so good, he would have gone into surgery.
So now I have a couple more specialty ideas to add to the mix. I don't think that I've ever been this unfocused in my interests. Ah well, I've still got a year to figure it out.
I arrived to some very happy dogs and a very green pool. I had also learned that my brother and sister had finally married their significant others. My brother was in town picking up his stuff, so he and Miho stopped by to make dinner and hang out with me. Dan and I stayed up until 1am playing Xbox together and talking. It was fun, but left me feeling a little unprepared for my OMM rotation in the morning.
After everyone left, it was time to pack up for the trip back. Becky, Julie and the boys headed back early the next morning. I flew back in the afternoon to arrive in time to prepare for new rotation starting at 8am Monday morning. It ended up that the boys were a handful and the women decided to pull an all nighter anyway, but I did sleep better in my bed than I would have in the back of the van.
My flight was fine. I purchased a book called Hostile Takeover I heard about on NPR that is taking me further left and more in the middle than ever before. The book makes some well documented points that being fiscally conservative today is as much anti-Republican (i.e. anti-Big Business) as anti-Democrat. It highlighted three disappointments:
1) Bush has betrayed the Reagan Republicans and squandered his legacy
2) Bush has given in to Big Business more than anyone in recent memory, at great cost to Americans freedom, privacy, financial and military security
3) What the heck happened to the Contract With America?
Anyway, I certainly don't trust the Demos more. Giving in to the NEA, labor and big, centralized government is no better. Time to get off the soapbox...
I met an incredibly interesting Doc on the flight back. He was an Air Force fighter pilot for 23 years, got his MBA, started Med School and 48, then went on to get Boarded in IM and EM! He's 68 and working 24x7 (8 days off in the last year!) as the only physician in a rural 16 bed hospital. The nearest Doc is 120 miles away! He's done a ton of interesting procedures and is making a bundle. Not only does he have incredible energy for a 68 yo, he said that if he knew his hands would still be so good, he would have gone into surgery.
So now I have a couple more specialty ideas to add to the mix. I don't think that I've ever been this unfocused in my interests. Ah well, I've still got a year to figure it out.
I arrived to some very happy dogs and a very green pool. I had also learned that my brother and sister had finally married their significant others. My brother was in town picking up his stuff, so he and Miho stopped by to make dinner and hang out with me. Dan and I stayed up until 1am playing Xbox together and talking. It was fun, but left me feeling a little unprepared for my OMM rotation in the morning.
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