Cardiology started by me getting assigned the first two weeks of this rotation in the hospital (inpatient) and the last two weeks at group's office across the street (outpatient). So the last three days have been my first experience seeing patients in the hospital setting.
It's been interesting and not nearly as intimidating as I expected. The H&P's are long and tedious, but I'm not as rushed as I probably will be next month on the Internal Medicine rotation. The first day I followed the group's Nurse Practitioner, two cardiologists and two intervention cardiologists around. I saw several patients, a couple catheterization/stent procedures and then a bunch of echocardiogram reviews at 6pm.
Yesterday was mostly didactics on campus, but I made it back to the hospital for some more stents and a nice meeting with one of the interventionists on establishing a gameplan for the rotation.
Today I started at 7am by seeing four patients myself and working (struggling) my way through Cardio Service progress notes that went into the patients' charts. Right after lunch I worked up a new patient and wrote a full H&P. That took about 2 hours. Finally, I rounded on about 15 patients including the ones I wrote up with my primary preceptor. He read my notes and seemed to like them! He also seemed to like my presentation of my H&P patient which was pretty complicated.
The hospital isn't as addicting as I imagined, nor is the cath lab. But I'm still having fun working as a team member, learning cardiology and integrating in the hospital environment. It will be great preparation for next month's rotation. I just hope I get some time to read and listen to lectures.
Wednesday, September 27, 2006
Sunday, September 24, 2006
15th Anniversary
Just realized I totally forgot to mention my attempt to make up for working through our 15th Anniversary. Saturday the 16th (a day late) after I attended the OBEX osteopathic disciplinary board, Becky and I went on a date.
We had a really nice dinner at a quaint Scottsdale Americana restaurant. The seafood was excellent and the atmosphere was great. Prices weren't bad either. And Becky explained the background of a lot of the artwork. One of her former co-workers was the artist of some interesting and unique paintings covering most of the walls.
Finally we headed to our movie, Little Miss Sunshine. I thought is was excellent, but Becky laughed so hard she had tears through most of it. It was like National Lampoon's Vacation movies, but done right. The acting, script and story were really good. I can't remember the last time we saw a movie so good that we continued throwing one-liners from it back at eachother two days later.
Not hugely romantic, but we did have a great time. Now I have to start thinking ahead towards her big 4-0 B-day next month...
We had a really nice dinner at a quaint Scottsdale Americana restaurant. The seafood was excellent and the atmosphere was great. Prices weren't bad either. And Becky explained the background of a lot of the artwork. One of her former co-workers was the artist of some interesting and unique paintings covering most of the walls.
Finally we headed to our movie, Little Miss Sunshine. I thought is was excellent, but Becky laughed so hard she had tears through most of it. It was like National Lampoon's Vacation movies, but done right. The acting, script and story were really good. I can't remember the last time we saw a movie so good that we continued throwing one-liners from it back at eachother two days later.
Not hugely romantic, but we did have a great time. Now I have to start thinking ahead towards her big 4-0 B-day next month...
Friday, September 22, 2006
Third Rotation Down
Finished Urgent Care today without much fanfare. I suppose I got what I wanted out of this rotation, lots of basic Family Medicine, charting, SOAP notes and patient exposure. But I am a bit disappointed by the lack of procedures. I wonder if IM will be much more interesting in that aspect.
So just finished my Preceptor eval, my logs (ugh!) and now my Blog. And it made me think that if I had to do it over again, I might choose a more rural rotation where I was free to do more even if the volume of URIs, UTIs and rashes was less.
Dr. Weiler was decent preceptor. In my eval he gave high marks for patient communication (heck, I got a bunch of compliments) but "meets expectations" for most of the medicine categories. He said that "Exceeds" is a student who presents a case in a very organized fashion, lists the differential, the desired tests and the meds with dosages. In other words, an MSIV or something with prior clinical training. I realize that I need to spend a lot more time on my FP objectives and reading, but he and I agreed that I couldn't meet those expectations with essentially two weeks of clinical exposure under my belt (Psych and OMM not really relevant).
He also said my Cardiology preceptors, who are just on other side of Banner Thunderbird Hospital, are very good. So I'm looking forward to that. I managed to get some reading in this week on the subject and listened to a CD on heart/lung sounds.
On the personal front, we had some good ClinEd lectures on Tuesday. Tucker and I then had lunch and talked in theoretical terms about starting a practice together in White Salmon. Who knows where that will go, but it's fun to visualize running a rural partnership.
Outside of that, I'm not swimming or exercising enough and playing too much Oblivion. I'm in the process of signing up for some tutoring which will be a little spending dough and a good impetus to get me out of the house and studying/reviewing something.
Onto my fourth rotation...
So just finished my Preceptor eval, my logs (ugh!) and now my Blog. And it made me think that if I had to do it over again, I might choose a more rural rotation where I was free to do more even if the volume of URIs, UTIs and rashes was less.
Dr. Weiler was decent preceptor. In my eval he gave high marks for patient communication (heck, I got a bunch of compliments) but "meets expectations" for most of the medicine categories. He said that "Exceeds" is a student who presents a case in a very organized fashion, lists the differential, the desired tests and the meds with dosages. In other words, an MSIV or something with prior clinical training. I realize that I need to spend a lot more time on my FP objectives and reading, but he and I agreed that I couldn't meet those expectations with essentially two weeks of clinical exposure under my belt (Psych and OMM not really relevant).
He also said my Cardiology preceptors, who are just on other side of Banner Thunderbird Hospital, are very good. So I'm looking forward to that. I managed to get some reading in this week on the subject and listened to a CD on heart/lung sounds.
On the personal front, we had some good ClinEd lectures on Tuesday. Tucker and I then had lunch and talked in theoretical terms about starting a practice together in White Salmon. Who knows where that will go, but it's fun to visualize running a rural partnership.
Outside of that, I'm not swimming or exercising enough and playing too much Oblivion. I'm in the process of signing up for some tutoring which will be a little spending dough and a good impetus to get me out of the house and studying/reviewing something.
Onto my fourth rotation...
Sunday, September 17, 2006
OBEX and Urgent Care
Spent my 15th wedding anniversary Friday taking a 4-hour neonatal resuscitation class from 8 until noon at school. Then said hello to a bunch of my MSII friends, checked out Cardio books in the bookstore and headed to Cigna Urgent Care. I expected a wild evening with my Preceptor and hoped for a bunch of procedures. But it was slow night and I ended up getting home at 10pm instead of midnight. This was still long past Becky's 9pm bedtime.
Saturday Tucker and I car-pooled over to OBEX, the Osteopathic disciplinary board hearings. We are all required to spend a day there, and there was at least 25 of us from AZCOM. It was very interesting and I completely agree that every medical student should be required to attend. We saw malpractice, substance abuse and licensing issues mostly. But it was great to see how the process worked and where Docs fail in documentation, staff management, judgment, etc.
My MSII summer Preceptor, Dr. Steinway, was even the President presiding over the board. We ended a bit early at 1pm so he gave us a chance to ask a bunch of questions directly to the board. Overall, it was a very informative 5 hours.
My rotation is going pretty well. I haven't written in couple weeks because not too much has changed. My charting is getting much better according to the attendings, but that should be expected since I'm seeing 20+ patients a day. I haven't seen a lot of ER crisis stuff. But I'm getting good at the basics: URIs, UTIs, sprains & strains, abdominal pain, chronic pain, etc.
UC isn't something I would want to do as a career, but I do think I'm getting the experience I had hoped for, as well as skills that will pay off in upcoming rotations.
It's down to my last week. And I'm at the point where I'm comfortable getting the history and doing the physical. I miss a test or two (e.g. Homan's Sign, Rovsing's sign) but I'm not quite ready to make diagnoses and write orders/prescriptions yet. I generally have some ideas, but there's always something to factor in: pregnancy, DM, warfarin usage, etc.
Finally, I'm really interested in learning more about the Scottsdale Healthcare FP residency program. It's unapposed and highly regarded in the area. The kids could stay in schools with their friends and Becky could stay at her position with St.Mary's. So I have to do some networking to learn more about it. I've tried unsuccessfully to reach one of our Fellows there, but I hope I can meet some residents at an AzAFP Journal Club. I met a bunch of local IM residents at their ACP Journal Club and was told its pretty similar with the AzAFP, but we'll see.
Oops, I have to mention that I'm not doing near enough studying. The boys and I went in together and got an Xbox 360, so I'm way behind on the objectives for Family and now it's time to bone up on Cardiology! Luckily Pass/Fail is very low stress compared to MSI & MSII :-).
Saturday Tucker and I car-pooled over to OBEX, the Osteopathic disciplinary board hearings. We are all required to spend a day there, and there was at least 25 of us from AZCOM. It was very interesting and I completely agree that every medical student should be required to attend. We saw malpractice, substance abuse and licensing issues mostly. But it was great to see how the process worked and where Docs fail in documentation, staff management, judgment, etc.
My MSII summer Preceptor, Dr. Steinway, was even the President presiding over the board. We ended a bit early at 1pm so he gave us a chance to ask a bunch of questions directly to the board. Overall, it was a very informative 5 hours.
My rotation is going pretty well. I haven't written in couple weeks because not too much has changed. My charting is getting much better according to the attendings, but that should be expected since I'm seeing 20+ patients a day. I haven't seen a lot of ER crisis stuff. But I'm getting good at the basics: URIs, UTIs, sprains & strains, abdominal pain, chronic pain, etc.
UC isn't something I would want to do as a career, but I do think I'm getting the experience I had hoped for, as well as skills that will pay off in upcoming rotations.
It's down to my last week. And I'm at the point where I'm comfortable getting the history and doing the physical. I miss a test or two (e.g. Homan's Sign, Rovsing's sign) but I'm not quite ready to make diagnoses and write orders/prescriptions yet. I generally have some ideas, but there's always something to factor in: pregnancy, DM, warfarin usage, etc.
Finally, I'm really interested in learning more about the Scottsdale Healthcare FP residency program. It's unapposed and highly regarded in the area. The kids could stay in schools with their friends and Becky could stay at her position with St.Mary's. So I have to do some networking to learn more about it. I've tried unsuccessfully to reach one of our Fellows there, but I hope I can meet some residents at an AzAFP Journal Club. I met a bunch of local IM residents at their ACP Journal Club and was told its pretty similar with the AzAFP, but we'll see.
Oops, I have to mention that I'm not doing near enough studying. The boys and I went in together and got an Xbox 360, so I'm way behind on the objectives for Family and now it's time to bone up on Cardiology! Luckily Pass/Fail is very low stress compared to MSI & MSII :-).
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