Sunday, July 18, 2010

Urgent Care

Only a few weeks into my third year rotations and I am seeing patients on my own. This is not indicative of my level of knowledge, but because it is a lot easier to throw me into the room and then teach me when I come out.

Hit the Ground Running

My Family Medicine rotation is a little different in that it is in various urgent care facilities across the Las Vegas valley. We see every age group, a large assortment of illnesses or injuries, and a fair number of patients in any given day. With my prior work experience in the Emergency Department I am familiar with the routine, but working out the problem medicinally is a new experience all together. I can't think of a better way to learn than to go through the motions, make a few mistakes, and move forward with some correction from the attending physicians. Each case has something unique to offer whether complicated or acute.

The physician hands me a chart and I'm off to see the patient. No doubt my exams are longer and more detailed than other providers, but I make every effort to get all the information I need the first time to avoid numerous visits for forgotten questions. After obtaining a detailed history and performing a focused physical, I discuss with the patient what I think might be ailing them. I have found this useful as it helps me build the case in words and thoughts so that in five minutes I can present the patient to my attending. The art of presenting a patient is a little more difficult than I expected. So many times I fail to include all the pertinent information leaving little holes in my reasoning for a particular diagnosis. After a little discussion with  the physician, and some occasional suggestive guidance, I build my differential diagnosis for testing and treatment plans.

I know that now is the time to be learning these critical clinical skills. Mistakes will happen and they are acceptable at this stage. Without being overbearing, I ask as many questions as I can and observe or perform any procedures possible. After all, I am still a student and this part of my education is meant to integrate the textbook with actual working principles. One thing is for sure, when I make the right diagnostic and treatment decisions, it is as good a feeling as an A on any quiz or test.

Board Prep Question of the Week
A 3-month old female is brought to the pediatric emergency room by her mother, who says the baby, "just doesn't seem right." On exam, you see a tired-appearing baby lying in her mother's arms who cries weakly when you begin to examine her. You note that her mucous membranes are moist, her anterior fontanelle is bulging, and she is tachycardic to 160. She also has a rash in the distribution of her diaper. What is the most important test for you to obtain at this point?

A. Blood culture
C. CSF Analysis
D. Urinalysis
E. Urine culture

Answer & Explanation 


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