I’ve noticed that one of my mentors, Dr. Jeffrey Brown at IU Health Arnett, often asks certain questions: “What are the most cost-effective next steps or tests in caring for a patient with [X]?” If X is syncope like a recent patient had, the answer is orthostatic (standing) blood pressure measurement and cardiac telemetry.
Another question he often asks: “How would you summarize that in one sentence?” It’s a great exercise, forcing the student to synthesize information, decide what’s most important, and express it clearly. For example, someone entered the room right as I was finishing my presentation of an article from JAMA’s The Rational Clinical Examination which answers the question, “Does This Woman Have an Acute Uncomplicated Urinary Tract Infection?” At his prompting I succinctly shared with her which symptoms, historical findings, and/or test results make a UTI likely enough to be diagnosed without a urine culture. I used to fear that I wouldn’t be able to explain well what I knew to patients (or to other doctors).
Another illustration of the importance of asking the right questions: One woman had diarrhea and vomiting; she thought she had caught something from her grandson. She confirmed that his symptoms had come first, so I thought her assumption was likely correct. Later, though, I found out from her physician that her symptoms had been present earlier than her grandson’s symptoms and had followed her taking Omnicef. Omni- means “all,” so it kills a lot of the normal bacteria in your gut, letting C. difficile grow unchecked in its newfound space. Vomiting is not a characteristic symptom of C. diff colitis, so I didn’t suspect it and ask the right questions.
Dr. Brown also encourages us to ask ourselves what we like and what we don’t like and to allow ourselves to feel that way. We will better serve patients if we choose our specialties by acknowledging and following what we love.
In other GREAT news, we have our first class baby! We are so excited that our “framily” has become multigenerational. The new baby girl came just in time to get home before the ice, snow, and freezing rain fell–otherwise, our classmate’s first delivery might have been of his own daughter. In an e-mail, my grandma let me know that she was thinking about her mom, whose birthday was Jan. 29, 1897. “Imagine having a baby in a sod house about 15 miles from any town. She was the middle child of thirteen, so I suppose there were family around during the ordeal, oh my!!” This made me thankful for modern medicine and less sorry about my own cabin fever from consecutive snow days. At least I’m in a solid cabin with heating. Besides, these days off have given me time to go through some USMLE World QBank questions and realize that I need to review only a few subjects:
etc. I’m thinking that from now on, my blog should be mostly about medical stories or mnemonics which aid in my preparation for boards. For example–the patient with syncope? It was likely due to a combination of overdiuresis, mild aortic stenosis (if the opening of this heart valve is too narrow, less blood gets pumped through it and to the brain), and other factors. I guess the helpful thing about Step 1 is that each question has only one answer.
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