Medical Sub-Specialization

Returning home to Las Vegas after touring the country means it's time to go back to rotations as usual. Fully expecting to hit some of the core specialties, I was surprised when I was assigned to urogynecology as an OB/GYN rotation.

Urogynecology

Initially, I expected to be listening for fetal heart tones, delivering babies and controlling irregular menstrual cycles. When first learned of the specialty, there was not much guesswork as to the line of work we would be dealing with: incontinent women and prolapsed organs. It is so specialized, that it would be similar to finding a surgeon that only operates on right hands. The patients we see are generally very satisfied with their outcomes after surgery, probably because it changes their lives significantly.

It's exciting to think these last few rotations will move faster than any before as things are rolling downhill with great momentum. Experiencing sub-specialized medicine definitely keeps the study topics to a minimum when all I can focus on is the rank list and match. At least there are some aspects in every field of medicine that can be used in emergency medicine. So I am looking for opportunities to gain from this rotation those things that will be pertinent to my future specialty. Needless to say, but this has been a uniquely educational month with far fewer babies than I had imagined.

Question of the Week

What are the symptoms of urinary incontinence?

Answer & Explanation

Leaving the Womb

There's nothing like getting an awesome two-for-one deal. In obstetrics they seem to come with every patient visit and with few strings attached - since the majority are using umbilical cords. (My apologies for the bad humor)



Development

Having only been on the OB/GYN service for a couple of weeks now, I am fascinated by the techniques and technology used to evaluate a patient that is barely tangible...the baby. With proper prenatal care, the physician can prepare for the baby's birth well in advance, hopefully avoiding unnecessary surprises on the day of delivery.With each birth, I try to learn something new to be better prepared for the next and acknowledge there is likely no such thing as a routine delivery. Assuming the preparatory work was adequate, the delivery should just be the next step in the process.

As a student I occasionally have a hard time absorbing the hands-on knowledge as I am often listening to my attending's teachings or worse, trying to come up with answers to his questions. After our last delivery, just when I thought I was in the clear and free to synthesize the information I had just experienced, he found more fodder for questioning. "What's this?" he asked as he held up one of the used instruments. Unfamiliar with the tools, I gave each my best guess as he continued to ask the name of everything laying on the sterile field. In a way I feel like I am in the womb of medical school being tested and prodded to make certain there is positive development. With any luck, my "delivery" into the medical profession will be uncomplicated and a day of celebration.

Question of the Week

In discussing Friedman's curve (a plot of obstetric evaluation of cervical progression over time), I was surprised to get a lesson in algebra. After defining the purpose of this graph I was promptly asked, "What is the equation of a line incorporating it's slope?" I was shocked by what my preceptor was asking, and both of us were surprised I remembered it so quickly. How well can you recall it?

Answer & Explanation

A Return to Physical Medicine

My psychiatry rotation was a month of patient or family interviews that provided very little physical examination. The dialogue was our exam. I may have used my stethoscope one time during the entire month and realized at the end how much I really miss medicine.

Mental vs. Physical Medicine

To me, medicine incorporates both the mental problem solving that finds physiological pathology and having physical contact with a patient. This is commonly done as we build our differential diagnosis while performing a physical exam. I feel like a medicinal detective being able to read the various clues from the body to solve an intricate puzzle. Interpreting how a sound, feeling or observation plays into a patient's health is intriguing as well as rewarding.

This month may be a little different. I have started my obstetrics and gynecology rotation. Assuming the patients are comfortable with my participation, I will certainly learn more this month than if I were to wait outside the exam room. Their permission aside, as a male it is difficult to empathize with them, since they experience symptoms that I will never know. Nonetheless, it is a unique specialty including surgery and clinical medicine. It promises to be a fast paced month with plenty of procedures and opportunities to learn. And I can once again use my stethoscope and all the other tools in my pocket.

Of note, both Life as a Medical Student and The Differential (another blog with my contributions) have been featured in this article, "Top 50 Health and Medical Blogs by Graduate Students." Although I don't think there is any meaning to the numbers assigned, it is nice to find blog included among the bunch.


Question of the Week

A 40 year old Caucasian male with a chronic history of paranoid schizophrenia presents to the mental health clinic. He tells you that his wife stole his bottle of risperidone, which he believes caused him to experience more frequent and intense auditory hallucinations. He says the voices tell him to kill his wife because she cannot be trusted. He admits to having homicidal thoughts about his wife but denies any specific plan for harming her. He requests a refill of his risperidone. What is the most appropriate next step?

A. Admit the patient to the psychiatric ward
B. Call the patient’s wife before filling the risperidone prescription
C. Increase his dose of risperidone
D. Refill his prescription of risperidone and call his wife after he leaves
E. Refill his prescription without calling his wife as he does not have a plan to harm her

Answer & Explanation