Daily Archives: January 16, 2013

Coat Tail

For one of our courses (Early Clinical Encounters), we have coat tail sessions where we’re assigned to a physician for a couple hours and basically follow them around/see real patients (although clearly, I’m just limited to taking patient histories right now). I love these sessions because it reminds me of why I’m in med school in the first place. I love being able to interact with real patients, and it makes not having a free clinic here to volunteer at a little better (if you can’t tell, I really miss PHAC; you better believe that if gas prices are not monstrous when I’m back in CA, I’ll be going up there as often as possible). They also help to cement/build upon/reinforce knowledge I already had, or to give me a preview of what is to come.

Last time, I followed one of my OPP professors around. He’d already taken his patient’s history, so he just talked me through what he was doing and showed me the FABER test and a number of other OMM techniques for treating low back pain. This time around, I followed around my Clinical Skills course director, who happens to work in Pediatrics. She is awesome, and I really liked being able to watch her work, because it was so obvious through how she interacted with the patients that she loves her field and is amazing at what she does. I had the 5-7 p.m. time slot (I didn’t even know the clinic was open that late), but she still had a number of patients, so she divided up the work and gave me different rooms to take patient histories on while she worked with other patients.I had about two moments where I was internally asking myself, “Seriously, Farrah? How could you possibly forget this?” In my defense, one of them was a misunderstanding, but she looked disappointed in me and I felt full of shame. :[

With patient histories, we’re generally told to follow the acronym, “OLDCAARTS.” I’m throwing in what goes on in my head when I ask these questions and not necessarily what I actually say to the patient. >_>
O: “onset”  (when the symptoms first started)
L: “location” (where the pain/symptoms are located)
D: “duration” (how long it’s been going on for)
C: “character” (what kind of pain it is, e.g. burning, aching, stabbing, dull, etc.)
A: “associated symptoms” (e.g. is there a fever/runny nose/etc. along with the cough?)
A: “aggravating factors” (what, if anything, makes it worse)
R: “relieving factors” (what, if anything, makes it better)
T: “temporal” (better or worse at different times of the day?)
S: “severity” (on a scale of 1-10, 10 being “holy crap what the hell is this?! life sucks” and 1 being “meh, I can live with this,” what would you rate it as?)

The last one might be a different word, but still, same meaning. I didn’t ask about enough associated symptoms and (this was the kicker) how the patient hurt his leg because I thought it had already been asked/covered in his chart. (sigh)

The other fail moment was when the patient’s mom was talking about how her uncle had the condition where the chest caved in. Or at least, that’s what I thought she said, so I answered that it was pectus excavatum (except since I was unsure of how to pronounce excavatum at the time, I just spelled it out). What she’d actually meant was when the chest puffed out (pectus carinatum), so my physician gave me one of them, “I’m so disappointed in you,” faces and I inwardly buried my head in shame. :[

All in all though, I think I made a crap ton of improvements with each new patient that I saw. I think being at clinic for so long definitely helped, since I’m at least not nervous about talking to the patients. It was kinda cool to just be thrown into the fire like that. No better way to learn, right? :D