Sunday, August 22, 2010
More South Africa pictures
Here are pictures from the Lion Ranch park, and yes that is a live full grown Lion! The other collage is from our township tour. You'll notice the pictures look a lot like those save the children ads you see on TV from time to time. It is so sad to see just how destitude they really are. Of course on the tour after they show how poor they are, they take you to a souvineer shop in the township and want you to spend a lot of money on overpriced lower quality merchandise. I bought quite a bit and I didn't dare bargain with them. Later in the trip I wished I had some of that money back to afford some better quality less expensive souvineers. Oh well. I helped the people in the township. :)
Physical Medicine and Rehabilitation
This was a two week rotation that commenced the week after I returned home from South Africa. For those who have never heard of Physical Medicine and Rehabilitation(PM &R), I will attempt to shed some light on my chosen field and highlight my experience on the rotation.
Physiatrists(PM &R), as explained by the AAPM &R website, are experts at diagnosing and treating pain, Restoring maximum function lost through injury, illness or disabling conditions, Treat the whole person, not just the problem area, Lead a team of medical professionals, Provide non-surgical treatments, Explain your medical problems and treatment plan, and Work not only on treatment but also prevention. Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians have completed training in the medical specialty physical medicine and rehabilitation (PM&R). Rehabilitation physicians treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician’s medical team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, and physical therapists. By providing an appropriate treatment plan, rehabilitation physicians help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime.
So there is a quick blurb on what a Physiatrist is and does. I spent two weeks with Dr. Mike in Mansfield Ohio, around 1 1/2 hours north of Columbus. I drove 30 minutes to his house, and then rode another hour with Dr. Mike every morning to get to his office. I enjoyed the first week riding with him as I learned firsthand of the lifestyle of a physiatrist, and all the positives and negatives about the specialty, but there are some things you learn about people that you never wanted to learn about them when riding in the car! :) The hours were not that bad if you take out the 3 hour round trip commute every day...and the constant boasting of Dr. Mike with his "6 board certifications and 181 certified IQ". Here are some of my impressions:
1. I liked how I could spend more time with patients then in family medicine. Also, there is a broad scope of diseases in PM & R but I at least know the neighborhood of where the diseases are coming from whereas in FP, you never know what will walk in the door.
2. I liked both musculoskeletal medicine and the neurological portion of the rotation. I wouldn't mind getting involved in Prosthetics and Orthodics.
3. I love how the goal of a physiatrist is to keep people from having surgery by using other means to restore health.
4. I used my Osteopathic Manual Medicine during this rotation which was fun to do!
5. I like the procedures and how you get a flavor of anesthesia, and radiology when doing injections.
6. It would be a fairly good lifestyle.
7. I could help people with impairments like my own.
8. I attended a couple of BOTOX parties...not sure if I want to get into that, but I would be trained to administer it during a PM & R residency. I turned down some beer at the party and they all thought I was crazy. haha.
For now, this is what I want to do. I head on a three month tour of PM &R starting next week in San Antonio, Texas. I will then do a month at the University of Utah, and lastly at Mayo clinic. I have to turn in my residency application on Sept. 1st and PM &R is my aim. If for some reason I absolutely hate the rotations coming up, I will likely switch to family medicine. Wish me all luck as I go through the crazy residency application process!
I also just finished the Step 2 COMLEX licensing Board exam last Wednesday. I took step 1 last summer and will take step 3 next year, and once I pass that I will officially be a licensed physician. So step 2 was another 8 hour, 400 question exam. Why I continue to pay 500 dollars for these exams and put myself through such craziness is beyond me. I never thought I would spend so many Friday and Saturday nights preparing for an exam either. But overall I was glad for the opportunity to study more about the treatment algorithms and pick up things that I missed during the rotations. Thank you Makenna for putting up with me and providing me with food and support so I could continue studying! Her last few weekends were pretty lame since she had a study crazed husband. Hopefully it will pay off someday.
Physiatrists(PM &R), as explained by the AAPM &R website, are experts at diagnosing and treating pain, Restoring maximum function lost through injury, illness or disabling conditions, Treat the whole person, not just the problem area, Lead a team of medical professionals, Provide non-surgical treatments, Explain your medical problems and treatment plan, and Work not only on treatment but also prevention. Rehabilitation physicians are nerve, muscle, and bone experts who treat injuries or illnesses that affect how you move. Rehabilitation physicians have completed training in the medical specialty physical medicine and rehabilitation (PM&R). Rehabilitation physicians treat a wide range of problems from sore shoulders to spinal cord injuries. Their goal is to decrease pain and enhance performance without surgery. Rehabilitation physicians take the time needed to accurately pinpoint the source of an ailment. They then design a treatment plan that can be carried out by the patients themselves or with the help of the rehabilitation physician’s medical team. This medical team might include other physicians and health professionals, such as neurologists, orthopedic surgeons, and physical therapists. By providing an appropriate treatment plan, rehabilitation physicians help patients stay as active as possible at any age. Their broad medical expertise allows them to treat disabling conditions throughout a person’s lifetime.
So there is a quick blurb on what a Physiatrist is and does. I spent two weeks with Dr. Mike in Mansfield Ohio, around 1 1/2 hours north of Columbus. I drove 30 minutes to his house, and then rode another hour with Dr. Mike every morning to get to his office. I enjoyed the first week riding with him as I learned firsthand of the lifestyle of a physiatrist, and all the positives and negatives about the specialty, but there are some things you learn about people that you never wanted to learn about them when riding in the car! :) The hours were not that bad if you take out the 3 hour round trip commute every day...and the constant boasting of Dr. Mike with his "6 board certifications and 181 certified IQ". Here are some of my impressions:
1. I liked how I could spend more time with patients then in family medicine. Also, there is a broad scope of diseases in PM & R but I at least know the neighborhood of where the diseases are coming from whereas in FP, you never know what will walk in the door.
2. I liked both musculoskeletal medicine and the neurological portion of the rotation. I wouldn't mind getting involved in Prosthetics and Orthodics.
3. I love how the goal of a physiatrist is to keep people from having surgery by using other means to restore health.
4. I used my Osteopathic Manual Medicine during this rotation which was fun to do!
5. I like the procedures and how you get a flavor of anesthesia, and radiology when doing injections.
6. It would be a fairly good lifestyle.
7. I could help people with impairments like my own.
8. I attended a couple of BOTOX parties...not sure if I want to get into that, but I would be trained to administer it during a PM & R residency. I turned down some beer at the party and they all thought I was crazy. haha.
For now, this is what I want to do. I head on a three month tour of PM &R starting next week in San Antonio, Texas. I will then do a month at the University of Utah, and lastly at Mayo clinic. I have to turn in my residency application on Sept. 1st and PM &R is my aim. If for some reason I absolutely hate the rotations coming up, I will likely switch to family medicine. Wish me all luck as I go through the crazy residency application process!
I also just finished the Step 2 COMLEX licensing Board exam last Wednesday. I took step 1 last summer and will take step 3 next year, and once I pass that I will officially be a licensed physician. So step 2 was another 8 hour, 400 question exam. Why I continue to pay 500 dollars for these exams and put myself through such craziness is beyond me. I never thought I would spend so many Friday and Saturday nights preparing for an exam either. But overall I was glad for the opportunity to study more about the treatment algorithms and pick up things that I missed during the rotations. Thank you Makenna for putting up with me and providing me with food and support so I could continue studying! Her last few weekends were pretty lame since she had a study crazed husband. Hopefully it will pay off someday.
Sunday, August 15, 2010
South Africa rotation!
Yes, I have heard those horns in real life. You know, the horns you heard on TV while watching the World Cup. And they were every bit as loud as they sounded on TV! :) I was very privileged to spend a month among the good people of South Africa from April 17th to May 14th, 2010. The opportunity came through the Des Moines University Global Health department, with this being one of many destinations available worldwide. They even paid 1700 of the 3000 dollars it cost to fund the entire trip...it was a deal and an experience of a lifetime too good to pass up! I had over 400 pictures from the trip and had a hard time choosing which ones to post. It took me a while to decide and then to figure out how to post a fraction of them(not to mention i've been a little bit busy with life), but I figured out how to use picasa so here we go. I'm still working on how to post more than four collages on a post, so forgive me for having a few different posts.
I started at Port Columbus International at 3 pm on Saturday, flew to Atlanta and caught a direct 16 hour flight to Johannesburg that arrived Sunday at 5 pm South African Standard(SAS) time, (which is six hours ahead of Eastern time and almost literally on the other side of the world). We spent the first night in J-burg. My two travel buddies and collegues for the trip were Mike Bowers who was also my former roomate in med school and Liliane Idylle- a 4th year med student who grew up in France but was actually Vietnamese. You'll see a few pictures of them. Everywhere you turned in J-burg you saw businesses and homes alike protected by huge cement walls. Crime is out of control there and you almost felt like you walked into a war zone. But once inside the walls of the Sunrock Guesthouse compound we stayed in, we felt very safe. We flew to our final destination the next morning, three hours north, to Polokwane(formerly Pietersburg-the name changed to a more African name after Apartheid fell). It felt much safer than Johannesburg. I would consider the size of Polokwane in terms of city borders to be that of Ogden, UT. The population was roughly 500,000. Lisa from Blessman ministries greeted us at the airport and gave us a South African survival crash course in the car as we headed to the Blessman Game Ranch. We learned there were 11 official languages with english being required of everyone to learn, though some do not. I'll never forget her describe how so many times she had been in the same room with an Africaan(white) and a black South African who, even though they both understood english, would not talk to each other and would use Lisa to relay the message to each other if they needed to communicate. Such were some of the feelings still lingering from Apartheid, though this was not the norm that I witnessed. I feel like they've come a long way in 20 years in getting rid of those differences and imaginery bounderies of race. We were also counseled to never go out after dark and be wise when choosing what water to drink. Sounds great eh? So Lisa took us on a mini Safari that evening before dusk and we saw Wildebeest, Impala, Warthogs, Girrafes, and Baboons. Our accomadations were amazing and we had hot running water with internet and I was beginning to think how comfortable it was to be in South Africa. The feeling didn't last long. We were taken to the hospital the next morning and were shown our permanent quarters for the month. You'll see the pictures. They could rival almost any horror story of accomadations from any returned missionary(at least from my mission:)). We were given our own dorm rooms in the nursing school dorms, with community bathrooms. There was a sink in the dorm room, and brown rusty water came rushing out the first time I turned it on. The heater didn't work(it was winter time in SA), and we had no refridgerator to store food. The toilets in the bathroom didn't have seats, you had to supply your own toilet paper, and had to pass by women and men in bathrobes(even I with the medical background had a hard time with this occasionally) on their way to shower. My shower had no curtain, only a sheet of plywood I moved back and forth to cover the entrance and I was grateful I had flip flops to protect my feet. We had hot water 80-90% of the time which was pretty good I admit. The were no lights in the bathrooms at night which made for some interesting night trips to the lou. All in all, it could have been worse.
Well, I will spare you with our day to day dealings and try to give the overall picture of the month and let the pictures do the rest of the talking. My first week I worked in the Casualties department at the hospital which was the equivalent of our Emergency department. Sounds like a pessimistic name I know, but I was actually impressed with the quality of physicians. They were constantly running out of supplies(Government run hospital...is this in our future?), and had to ration when to use X-ray/CT/MRI, but most could rival and surpass almost any American physician when having to diagnose a patient relying only on the history and physical alone. I quickly wished with my hearing that I had subtitles for some of the harsh SA Accents, as they were hard to understand. Toward the end of the trip I was picking things up pretty well. One of my favorite stories from the Casualties Department was on our first day. There was a patient who we suspected had meningitis(which is so, so common down there along with TB and HIV), and us american students concluded we needed a lumbar puncture. We told this to the doctor in charge and he said "sure go ahead, you can do it." Between us, we had witnessed a couple of lumbar punctures and I was shocked this doctor was willing to let a couple of students on their first day with the service just "go ahead" and do it without knowing if we were capable. I then thought about protecting him from any law suits if something went awry asked him if we needed to get informed consent from the patient to do the procedure. He stated "we don't worry about the legal system here, so no need to get it." Wow. From a physician point of view that sounded awesome! To be able to go through my career as a doctor and not worry about malpractice would be sweet. But it was a little scary from the patient point of view. My other favorite experience was when a drunk man came in after getting hit in the head with a beer bottle, and the doctor asked me if I knew how to suture. I said a little bit, so he got me a pan and filled it with water and soap, handed me a big suturing needle and needle driver that was normally used to sew up abdomens. He then left me alone in the room with this man who was bleeding profusely, to stop the bleeding and put in scalp stitches. I had sewed a couple of arm lacerations and pigs feet in med school, but never a bleeding scalp! The man survived and I put in the sutures...but it was a crazy experience!
The next week I spent in the HIV clinic. I essentially listened to the doctors deciding what regimen HIV patients should be on for as many people they could see in a day. It is a sad story there because 1/3 of SA population is infected by HIV, and it wasn't until 2006 that the president acknowledged HIV led to AIDS. They have a whole generation of people dying of HIV.
The third week I worked at a family practice clinic with Dr. Raza. He was an amazing Pakistanian who fled to South Africa with his family after the Taliban tried to take his life for doing some of his medical training in America. Here I saw a wide variety of conditions, although most were related to TB or HIV compications. No patients had appointments, it was a first come first serve type of deal. So the patients would all arrive at 7 am in the morning and likely would wait hours, even until 5, 6 pm or midnight to be seen. I hope it wasn't a foreshadowing of where America's health care is heading.
The last week I spent with Orthodics and Prosthetics and saw how people who had lost limbs were able to walk again. It was really cool and I hope to perhaps be involved in something similar one day. I also got to cast on my own literally dozens of little children with club feet...an experience I would've never found in the states. It was very rewarding!
We spent our weekends experiencing the rich culture and tourism of South Africa. Our first weekend we stayed close to home and went to the Protea Lion Ranch Hotel. Here they had raised an entire pride of lions from infancy and allowed us to go into the compound and actually touch the lions! It was so nerve racking but oh so cool! On Sunday we walked 45 minutes to get to church(I really felt like a pioneer in a foreign land), but it was so cool to see the faith of these african saints. We were blessed after church to be fed by the senior couple missionaries who provided a wonderful and much needed break from the hospital food we had been eating three times a day for weeks.
Our second weekend we flew across the country to the most southern tip of africa, Cape Town. This city felt more like California than Africa. It was so beautiful, the weather was perfect and we even dipped our hands on the other side of the Atlantic ocean! Not many people can say they've been to both sides of the Atlantic. We saw the huge World cup soccer stadium, drove the coastline and saw majestic cliffs and beaches, and even saw african penguins on one of the beaches! We climbed Table mountain(actually rode in a cable car to the top), and saw the very tip of the african continent. We also went on a township tour and saw how dirt poor some of those people really are, and walked through a museum dedicated to remembering Apartheid...it was very eye opening. We stayed in a hostel and got to experience first hand how comfortable european women are changing in front of complete strangers...ackward!
And for our last weekend, we went to Kruger National park and went on three safari's. This was my favorite as I've been dreaming to go on a Safari for as long as I can remember. You know you are in a different world when the gatekeeper at the parks entrance instructs you to not get out of your car for any reason and go directly to your campsite. I asked why(i'm sure its all obvious to you, but I had to ask) and she said "you're not at the zoo, there are wild animals that will eat you!" That was enough for me to stay in the car. We went on one Safari in the evening, and two in the early morning with one being a hike and the other driving. We actually saw more animals when driving around on our own in our rental car though. Funny how that works. We saw elephants(they were everywhere, almost like squirrels), impala, water buck, water buffalo, girrafe, hippo, owls, cranes, alligators, hyena, rabbit, deer, kudu, zebra, wildebeest, baboons,vervet monkeys and hundreds of colorfully rich birds all in their natural habitat. On the way there, I got pulled over for speeding and contrary to what i've heard about police in foreign countries, these cops did not accept bribes. ;) On the way home we drove to Gods window, which is like a green grand canyon and witnessed the beautiful majesty as the sun went down. We drove through several towns on our way home and saw rural South Africa. I was impressed with how diverse the SA landscape was and the beautifulness of God's earth no matter where you are. The people are good and I hope their country will continue to get better and better! I would like to go there again someday and do all the things we were unable to do in three short weekends. I missed Makenna terribly and that was the worst part of the trip, but we were able to Skype nearly every night and that made it more bearable. Next time I will have her with me. Well, I could talk in more detail about everything, but I've already spent way too long on this post(don't ask how long), so this is where the text ends and the pictures begin. Thank you for letting me share with you one of the most amazing months of my life to date!
I started at Port Columbus International at 3 pm on Saturday, flew to Atlanta and caught a direct 16 hour flight to Johannesburg that arrived Sunday at 5 pm South African Standard(SAS) time, (which is six hours ahead of Eastern time and almost literally on the other side of the world). We spent the first night in J-burg. My two travel buddies and collegues for the trip were Mike Bowers who was also my former roomate in med school and Liliane Idylle- a 4th year med student who grew up in France but was actually Vietnamese. You'll see a few pictures of them. Everywhere you turned in J-burg you saw businesses and homes alike protected by huge cement walls. Crime is out of control there and you almost felt like you walked into a war zone. But once inside the walls of the Sunrock Guesthouse compound we stayed in, we felt very safe. We flew to our final destination the next morning, three hours north, to Polokwane(formerly Pietersburg-the name changed to a more African name after Apartheid fell). It felt much safer than Johannesburg. I would consider the size of Polokwane in terms of city borders to be that of Ogden, UT. The population was roughly 500,000. Lisa from Blessman ministries greeted us at the airport and gave us a South African survival crash course in the car as we headed to the Blessman Game Ranch. We learned there were 11 official languages with english being required of everyone to learn, though some do not. I'll never forget her describe how so many times she had been in the same room with an Africaan(white) and a black South African who, even though they both understood english, would not talk to each other and would use Lisa to relay the message to each other if they needed to communicate. Such were some of the feelings still lingering from Apartheid, though this was not the norm that I witnessed. I feel like they've come a long way in 20 years in getting rid of those differences and imaginery bounderies of race. We were also counseled to never go out after dark and be wise when choosing what water to drink. Sounds great eh? So Lisa took us on a mini Safari that evening before dusk and we saw Wildebeest, Impala, Warthogs, Girrafes, and Baboons. Our accomadations were amazing and we had hot running water with internet and I was beginning to think how comfortable it was to be in South Africa. The feeling didn't last long. We were taken to the hospital the next morning and were shown our permanent quarters for the month. You'll see the pictures. They could rival almost any horror story of accomadations from any returned missionary(at least from my mission:)). We were given our own dorm rooms in the nursing school dorms, with community bathrooms. There was a sink in the dorm room, and brown rusty water came rushing out the first time I turned it on. The heater didn't work(it was winter time in SA), and we had no refridgerator to store food. The toilets in the bathroom didn't have seats, you had to supply your own toilet paper, and had to pass by women and men in bathrobes(even I with the medical background had a hard time with this occasionally) on their way to shower. My shower had no curtain, only a sheet of plywood I moved back and forth to cover the entrance and I was grateful I had flip flops to protect my feet. We had hot water 80-90% of the time which was pretty good I admit. The were no lights in the bathrooms at night which made for some interesting night trips to the lou. All in all, it could have been worse.
Well, I will spare you with our day to day dealings and try to give the overall picture of the month and let the pictures do the rest of the talking. My first week I worked in the Casualties department at the hospital which was the equivalent of our Emergency department. Sounds like a pessimistic name I know, but I was actually impressed with the quality of physicians. They were constantly running out of supplies(Government run hospital...is this in our future?), and had to ration when to use X-ray/CT/MRI, but most could rival and surpass almost any American physician when having to diagnose a patient relying only on the history and physical alone. I quickly wished with my hearing that I had subtitles for some of the harsh SA Accents, as they were hard to understand. Toward the end of the trip I was picking things up pretty well. One of my favorite stories from the Casualties Department was on our first day. There was a patient who we suspected had meningitis(which is so, so common down there along with TB and HIV), and us american students concluded we needed a lumbar puncture. We told this to the doctor in charge and he said "sure go ahead, you can do it." Between us, we had witnessed a couple of lumbar punctures and I was shocked this doctor was willing to let a couple of students on their first day with the service just "go ahead" and do it without knowing if we were capable. I then thought about protecting him from any law suits if something went awry asked him if we needed to get informed consent from the patient to do the procedure. He stated "we don't worry about the legal system here, so no need to get it." Wow. From a physician point of view that sounded awesome! To be able to go through my career as a doctor and not worry about malpractice would be sweet. But it was a little scary from the patient point of view. My other favorite experience was when a drunk man came in after getting hit in the head with a beer bottle, and the doctor asked me if I knew how to suture. I said a little bit, so he got me a pan and filled it with water and soap, handed me a big suturing needle and needle driver that was normally used to sew up abdomens. He then left me alone in the room with this man who was bleeding profusely, to stop the bleeding and put in scalp stitches. I had sewed a couple of arm lacerations and pigs feet in med school, but never a bleeding scalp! The man survived and I put in the sutures...but it was a crazy experience!
The next week I spent in the HIV clinic. I essentially listened to the doctors deciding what regimen HIV patients should be on for as many people they could see in a day. It is a sad story there because 1/3 of SA population is infected by HIV, and it wasn't until 2006 that the president acknowledged HIV led to AIDS. They have a whole generation of people dying of HIV.
The third week I worked at a family practice clinic with Dr. Raza. He was an amazing Pakistanian who fled to South Africa with his family after the Taliban tried to take his life for doing some of his medical training in America. Here I saw a wide variety of conditions, although most were related to TB or HIV compications. No patients had appointments, it was a first come first serve type of deal. So the patients would all arrive at 7 am in the morning and likely would wait hours, even until 5, 6 pm or midnight to be seen. I hope it wasn't a foreshadowing of where America's health care is heading.
The last week I spent with Orthodics and Prosthetics and saw how people who had lost limbs were able to walk again. It was really cool and I hope to perhaps be involved in something similar one day. I also got to cast on my own literally dozens of little children with club feet...an experience I would've never found in the states. It was very rewarding!
We spent our weekends experiencing the rich culture and tourism of South Africa. Our first weekend we stayed close to home and went to the Protea Lion Ranch Hotel. Here they had raised an entire pride of lions from infancy and allowed us to go into the compound and actually touch the lions! It was so nerve racking but oh so cool! On Sunday we walked 45 minutes to get to church(I really felt like a pioneer in a foreign land), but it was so cool to see the faith of these african saints. We were blessed after church to be fed by the senior couple missionaries who provided a wonderful and much needed break from the hospital food we had been eating three times a day for weeks.
Our second weekend we flew across the country to the most southern tip of africa, Cape Town. This city felt more like California than Africa. It was so beautiful, the weather was perfect and we even dipped our hands on the other side of the Atlantic ocean! Not many people can say they've been to both sides of the Atlantic. We saw the huge World cup soccer stadium, drove the coastline and saw majestic cliffs and beaches, and even saw african penguins on one of the beaches! We climbed Table mountain(actually rode in a cable car to the top), and saw the very tip of the african continent. We also went on a township tour and saw how dirt poor some of those people really are, and walked through a museum dedicated to remembering Apartheid...it was very eye opening. We stayed in a hostel and got to experience first hand how comfortable european women are changing in front of complete strangers...ackward!
And for our last weekend, we went to Kruger National park and went on three safari's. This was my favorite as I've been dreaming to go on a Safari for as long as I can remember. You know you are in a different world when the gatekeeper at the parks entrance instructs you to not get out of your car for any reason and go directly to your campsite. I asked why(i'm sure its all obvious to you, but I had to ask) and she said "you're not at the zoo, there are wild animals that will eat you!" That was enough for me to stay in the car. We went on one Safari in the evening, and two in the early morning with one being a hike and the other driving. We actually saw more animals when driving around on our own in our rental car though. Funny how that works. We saw elephants(they were everywhere, almost like squirrels), impala, water buck, water buffalo, girrafe, hippo, owls, cranes, alligators, hyena, rabbit, deer, kudu, zebra, wildebeest, baboons,vervet monkeys and hundreds of colorfully rich birds all in their natural habitat. On the way there, I got pulled over for speeding and contrary to what i've heard about police in foreign countries, these cops did not accept bribes. ;) On the way home we drove to Gods window, which is like a green grand canyon and witnessed the beautiful majesty as the sun went down. We drove through several towns on our way home and saw rural South Africa. I was impressed with how diverse the SA landscape was and the beautifulness of God's earth no matter where you are. The people are good and I hope their country will continue to get better and better! I would like to go there again someday and do all the things we were unable to do in three short weekends. I missed Makenna terribly and that was the worst part of the trip, but we were able to Skype nearly every night and that made it more bearable. Next time I will have her with me. Well, I could talk in more detail about everything, but I've already spent way too long on this post(don't ask how long), so this is where the text ends and the pictures begin. Thank you for letting me share with you one of the most amazing months of my life to date!
Sunday, June 27, 2010
A quick Blurb about Rotations #7 - #12
It's been a busy year. I don't need to justify myself for not posting more often on this blog...yet I feel like need to do just that. I don't have a monstrous fan base waiting on the edge of their seats for my outlooks on rotations or medical school...but it is fun for me to go back and read my impressions about the rotation as I am getting ever so close to decision time on what specialty I want to do for the rest of my life. So I am a bit remiss that I will be exercising brevity for essentially half of my junior year of medical school. But if I am to ever catch up, this is what I need to do. So buckle up because I'm going to fly through these rotations!
#7 Radiology - This was a two week rotation of pure boredom. Really. The hours were fantastic...started at 8 am and was done at 2 pm...but the work was ultra boring. In the morning I would go to the library and do the online PowerPoint presentations that taught how to read x-rays, MRI's and CT scans. These were very helpful and gave me a nice base to start from if I ever have to read my own film. But the afternoons were dreadfully boring as I sat in the dark reading room with the residents and watched them read and interpret the images. It was all digital of course...everything posted on the network. But for the very reason I did not go into computer programming would I not go into radiology- you just sit in front of a computer all day(though the pay is much better than computer programming) with hardly any social interaction. So even though I was an x-ray tech and wanted to do radiology before i went to med school, not anymore! Enough said.
#8 Anesthesiology - This was a fun rotation. I quickly learned about propofol(the drug that killed MJ-Michael Jackson) as it was used in nearly every surgery case we did. It's a great drug with a short half life and few side affects-and as long as you have control of the airway and are monitoring the vital signs no one should ever die because of it. MJ's doctor really did commit manslaughter in my opinion and should not be allowed to practice medicine. Anyway, I enjoyed practicing intubation and putting in LMA's, filling the syringes and administering the medications via IV, and doing the pre-surgery assessment with the patient. I enjoyed talking with the patients and helping ease their fears of surgery-because it can be scary- and found a lot of satisfaction in it. I would likely be heading into this field if it were not for my hearing. I just had a hard time hearing people in the OR with everyone wearing masks. Those rooms were not built with acoustics in mind. I didn't realize just how much I rely on reading lips to communicate. I think my overall satisfaction would be low because of this and may also be a patient safety issue.
#9 General Surgery - It was a very interesting and enlightening rotation and I am sure the experience will help me become a better physician...but I am not a surgeon. The most distressing part about general surgery was how plain rude and jerky the surgeons were. I noticed an interesting correlation between the year of residency the residents were in and the "niceness" of the resident. The older the resident was the more rude and arrogant they became. I didn't want that to become me and for that very reason I will stay away from surgery. But some of the highlights of the rotation were being allowed to scrub into the surgeries and being right there at the table. My job was mostly to cut sutures and hold retractors while the surgeons did their work and also "pimped" us on the general anatomy and other random questions about the surgery. Occasionally they would let me put in a suture or two but usually everybody wanted to go home and didn't want to wait for the slow med student to suture the patient up, so those opportunities were few and far between. I actually got lucky for 2 of the 4 weeks and worked on a vascular surgery team. These guys were so much nicer than the general surgeons and I actually enjoyed going to work on that service. I saw a lot of AV fistulas built for dialysis patients and also saw the magnificent work of Dr. Brightwell as he carefully sewed together the smallest of blood vessels! Really, it was pretty amazing to watch. The senior resident was named Altin and he had migrated from Albania by himself at age 16. He was a remarkable story of the true American dream of coming from having literally nothing to being just a few years away from becoming an American trained surgeon. Quite an accomplishment! My hours were dreadfully long, usually starting at 5:30 am and sometimes not leaving the hospital until after 8 pm. And then I had to go home and read about the next days surgeries so I wouldn't look like a complete idiot(although I usually did anyway ;) ). So in nutshell, surgery is not for me.
#10 Psychiatry - Wow. This was a very interesting and crazy rotation. And I only did outpatient. I'm sure if I worked in a mental hospital, it would've been even more crazy. To sum up the majority of patients, I would say most were just sad, sad stories of people who either got themselves in bad or stressful situations or a family member put themselves in a bad or stressful situation, and the patient could not handle the stress and had a breakdown. Then they were given the diagnosis of bipolar, or schizophrenic or depression and forever after have lived believing they were messed up. Now, don't get me wrong, I truly believe there are psychiatric disorders. It just seems like most were started from a single stressor or a multitude of stressors that acted like a trigger button to turn on the illness. I wonder if these people had had better tools to handle stress, if they would be in the same place with the same diagnoses they are in today? A lot of the illnesses have a genetic pattern to them and some even have neurotransmitter and chemical imbalances in the brain. I find Psychology fascinating and the hours worked really wouldn't be too bad. But I just don't think I could handle hearing sad story after sad story, day in and day out, without diagnosing myself with some psychiatric disorder before long! ;) The most bizarre story I witnessed came from an 11 year old boy who was there to see the child psychiatrist. When asked why he was there by the physician, he replied "I play with my feces!" Gross. I wanted to stop there, but of course we had to get to the bottom of this. He was a very articulate and intelligent kid who probably had a larger vocabulary than most adults. That's what made the case so interesting. If he were mentally handicapped it wouldn't have been so unusual. So we probed further and discovered he felt bad for his actions but for some unknown reason even he couldn't explain, he would use his feces to write on the wall or hide it under the couch cushions or other obscure places. I won't bore you with the rest of the details but we finally concluded he was experiencing psychosis and maybe some childhood depression. It was a weird case. So anyway, in case you were wondering...psychiatry is not for me.
#11 International Health - South Africa! Yes, I spent an entire month in South Africa working in the government hospital in Polokwane, Limpopo, South Africa! This rotation deserves an entire blog post with pictures. And I will try to post it in a reasonable time frame.
#12 Physical Medicine and Rehab - This was a 2 week rotation and also deserves a separate blog post since it currently has the lead for my specialty of choice and is also a field that not many people outside of medicine know much about. I really enjoyed it....and wished I preferred to work in PM & R over watching a football game or recreating...but I just don't think that specialty is out there for me.
In other exciting news, we had quite a few visitors come stay with us this semester:
Lichelle came and spent a night with us toward the end of her whirlwind tour of the Eastern U.S. in April before I left to S.A., and we had a blast taking her to the Columbus sights and talking till late! It was so fun to see someone in our apartment from home and we loved having her fun presence here! We even saw Trent an hour before he flew back to Utah and I got to show him the "Horseshoe" Ohio State's football stadium. Thanks for coming guys and feel free to visit again, we would love it!
Mark and Gina, aka Dad and Mom, paid homage to our Columbus abode toward the end of April while I was in S.A. and spent a couple of days with Makenna. She was a good tour guide I heard and showed Mom and Dad the Columbus sights, my old apartment, the hospitals where I've worked and even the capitol building. I was grateful they could make it out and spend some time with Mak while I was gone. Thanks guys for coming and taking care of my wife! Please come again when I am around! :)
Hillary(Mak's sister) was our next visitor and she came for a week in May while I was still in S.A. I heard they got good quality sister time, you know, the shopping galore, staying up late watching their favorite t.v. shows and eating frozen yogurt. I'm sure Mak was glad I wasn't around for that week! ;) Thanks for coming Hill and do come again when I'm around, it would be fun!
We then were thrilled to receive a visit from my sister Emily. She stayed with us for four day and 1/2 days on her tour to see her prison enslaved and shackled..er...her medical school attending brothers. :) She arrived the week after I returned from S.A. We enjoyed touring Columbus with her and hearing at night after Mak and I got of work about her adventures of exploring the city alone. Don't worry Ems, my blinker was not stolen by the psychotic types you accidentally parked my car next to! ;) We enjoyed playing games at night, eating Ethiopian food, hearing about the possible ways we could die wherever we went with you, and chatting! Thanks for visiting and we hope to see you again out here!
Our last visitor was Makenna's twin sister Madi. Ok, they really aren't twins, but they sure look an awful lot alike. She flew home with us after our short trip to Utah(which also deserves a blogpost...but suffice to say we loved seeing everybody we got to see during our short time there and love you all!). She spent an entire week with us. She would stay up really late, sleep in till late and work on her quilt and giraffe craft until Mak and I got home. Again we enjoyed touring the city with her and I enjoyed a nice waffle house lunch with her. Mak took her shopping and had some good sister time while I studied. It was fun to have someone come home with us and felt like we had a longer vacation than our short stay in UT. She got a unique experience, one she may never forget. Makenna's "Black Beauty" Kia sorrento broke down as we were traveling home from Cedar Point(the amusement park)at 11 pm, completely and utterly dying in the middle of nowhere Attica, Ohio. Luckily we have emergency roadside assistance through American family insurance, and after one call to them, they took care of us. We had the car towed to our apartment in Galloway, 94 miles away, and didn't arrive home until 4 am. We're hoping to get the car fixed this week and hope our checkbook can absorb the blow. On the bright side, Mak and I have gotten to spend more time together as I've been taking her to work and picking her up and i've enjoyed it. Anyway we were happy to have Madi along for the ride and glad she came to visit! Please come again, we sure had fun!
We loved all our visitors and hope to have many more! OK, I'm almost caught up...just a few more blog posts and I'll be there. Although this was a long post, it's pretty darn short for the amount of ground we covered. Thanks for sticking with it and look for my African post in the future.
Sunday, March 28, 2010
Rotation #6 Emergency Medicine
Who has seen ER? I have never watched an episode, but I'm here to tell you that I worked in the ER for a month in January and I'm sure that everything you've seen on TV about the Emergency Room is absolutely true! Ok, that is a lie. So what is it really like working in the ER? It is very different than I anticipated it to be. I expected everyone running around frantically with total chaos trying to save as many lives as possible that were on the brink of death. What is the reality? There is a very methodical and structured atmosphere in the ER. I learned a great deal about what those physicians face on a daily basis and also how the entrance point to health care for many is structured.
Let me begin by painting the picture of the particular Emergency Department(ED) I worked at. Grant Medical Center is located in the heart of downtown Columbus. I described it in my earlier post about my OB/GYN rotation because I did these two rotations at the same hospital. It is very inner city, and not the safest area of Columbus. It was a common thing for thugs to drive their car to up to the door of the ED, push a gun shot wounded buddy out of the car, leave him on the curb and drive off to avoid questioning from the police. The ED is a Level 1 Trauma center, meaning it has the resources and specialists to handle the worst of the worst trauma cases in the state. Another interesting fact about the Grant ED is because of its location, the patient population comes from a very poor socioeconomic class. So hopefully you get the idea of the conditions. What was my role as a medical student in the ED? It was much more independent than any of my previous rotations had been. I was used to working closely with one physician and followed very closely what they did, breathing when they told me to breath, doing only what they wanted done, you get the idea. In the ED, I worked with a different doc every day, with the first doc I worked with telling me he didn't need a shadow and to only contact him on the radio after I saw a patient. I was to watch the computer, pick a patient to see, do what I thought was necessary, and report to him. Hello. Wake up call. I'm pretty sure he thought I was a 4th year who knew what he was doing rather than a 3rd year with no ED experience and only 5 months of rotation experience to date. It took some getting used to, but by the end of the rotation, I really enjoyed the independence and trust given to me. Before you get too concerned about a med student seeing people in the ER alone, I would always look at the vitals before seeing a patient to make sure it wasn't a true emergency, and then I would see them. I gained valuable experience interviewing patients and doing physical exams. I was forced to think through situations and got to help decide what the best course of action was for my patients. I got a lot of practice putting in IV's, Foley catheters, and doing other procedures. And when the big trauma's came either by life flight or ambulance, I got to witness first hand the valiant people who worked so hard EVERY time to save lives. Here are a few of my observations(for some it may dishearten you and for others it may shed some light on why healthcare costs are out of control in this country) :
1. My favorite experience of something I did myself: It's a tie between using a pair of pliers to yank out an industrial staple from the finger of a 62 year old man(that I numbed up with lidocaine of course) and stitching up a 3 inch wide by 2 inch deep cut on a 25 year old man who punched a window on new years eve because he was drunk and angry.
2. The craziest story about a patient: There were a lot of crazy stories, some being factual and some contrived on the part of the patient so they could get their pain meds, but here is the best factual one. On new years day, a gentlemen who we will call george, reported to the triage nurse of face pain around 4 am. He said he was hit in the face by someone or something but wasn't sure what and that he was "minding his own business" when it happened. So the nurse put him in a room to wait for the doctor to see him, figuring it was not serious and did not need urgent care. Well, I show up to see him 3-4 hours later (it is really busy on new years day in the ED) and he has a blood stained nose that is very swollen. He tells me a similar story to what he told the nurse, and so the attending doc decides to get a CT scan of his face to rule out anything major. Well, a few hours later, the CT scan shows shrapnel from a bullet that is throughout his sinuses and underneath his skin! This man had been shot in the face! He should've been a trauma patient and seen immediately but instead waited 6 hours before he got attention! I don't know if this guy was trying to hide something or really had no idea he'd been shot in the face, but we were all grateful no important structures were damaged. Crazy, eh!
3. 90% of patients in the emergency department do not need to be in the ED. Period. Sadly, most of the patients in this ED either presented with strep throat, colds, headaches...things that they should've seen a family doctor for, or came in with stories of pain in order to get the narcotic pain meds that they were either addicted to or are going to sell on the street. The reality is there is a small part of our society that uses up a considerable amount of resources. They treat the ambulance as the big red taxi to the hospital to get their pills. They know they won't be turned away if they can't pay, so they come for anything and everything. They say the right buzz words and the ER doc is forced to order CT scans, lab tests etc that cost thousands of dollars in order to protect himself from the people who are trying to play the lottery and find a doc who "messes up" so they can sue for millions of dollars. It's a very sad and disheartening reality. I believe this is a big reason why medical costs have skyrocketed. That is all I want to say about politics.
4. Emergency Physicians surprisingly have very good lifestyles. Most work 18-10 hour shifts a month and get the rest of the month off. The average pay is 300k. They are contractors for the hospital and don't have to worry about starting an office and absorbing those associated costs. I loved working in the ED for the first 3 weeks of the rotation while working days, but absolutely hated it when I worked the overnight shift several times during my last week. That is one of the downsides with emergency medicine. Also, you will likely work a lot of nights, weekends and holidays. They have one of the highest burnout rates of any physician. It is a very high stress environment, especially at night.
5. The most exciting trauma: Seeing the skin and some facial muscles dangling from a man's face after he hit a tree driving a car under the influence of alcohol. He survived without any brain damage...it was pretty crazy. It was cool to see that no matter what the person did to get to the trauma room, they received the same great care.
I really enjoyed the rotation and strongly considered going into EM for a while, but for some of the reasons stated above have decided against it.
Let me begin by painting the picture of the particular Emergency Department(ED) I worked at. Grant Medical Center is located in the heart of downtown Columbus. I described it in my earlier post about my OB/GYN rotation because I did these two rotations at the same hospital. It is very inner city, and not the safest area of Columbus. It was a common thing for thugs to drive their car to up to the door of the ED, push a gun shot wounded buddy out of the car, leave him on the curb and drive off to avoid questioning from the police. The ED is a Level 1 Trauma center, meaning it has the resources and specialists to handle the worst of the worst trauma cases in the state. Another interesting fact about the Grant ED is because of its location, the patient population comes from a very poor socioeconomic class. So hopefully you get the idea of the conditions. What was my role as a medical student in the ED? It was much more independent than any of my previous rotations had been. I was used to working closely with one physician and followed very closely what they did, breathing when they told me to breath, doing only what they wanted done, you get the idea. In the ED, I worked with a different doc every day, with the first doc I worked with telling me he didn't need a shadow and to only contact him on the radio after I saw a patient. I was to watch the computer, pick a patient to see, do what I thought was necessary, and report to him. Hello. Wake up call. I'm pretty sure he thought I was a 4th year who knew what he was doing rather than a 3rd year with no ED experience and only 5 months of rotation experience to date. It took some getting used to, but by the end of the rotation, I really enjoyed the independence and trust given to me. Before you get too concerned about a med student seeing people in the ER alone, I would always look at the vitals before seeing a patient to make sure it wasn't a true emergency, and then I would see them. I gained valuable experience interviewing patients and doing physical exams. I was forced to think through situations and got to help decide what the best course of action was for my patients. I got a lot of practice putting in IV's, Foley catheters, and doing other procedures. And when the big trauma's came either by life flight or ambulance, I got to witness first hand the valiant people who worked so hard EVERY time to save lives. Here are a few of my observations(for some it may dishearten you and for others it may shed some light on why healthcare costs are out of control in this country) :
1. My favorite experience of something I did myself: It's a tie between using a pair of pliers to yank out an industrial staple from the finger of a 62 year old man(that I numbed up with lidocaine of course) and stitching up a 3 inch wide by 2 inch deep cut on a 25 year old man who punched a window on new years eve because he was drunk and angry.
2. The craziest story about a patient: There were a lot of crazy stories, some being factual and some contrived on the part of the patient so they could get their pain meds, but here is the best factual one. On new years day, a gentlemen who we will call george, reported to the triage nurse of face pain around 4 am. He said he was hit in the face by someone or something but wasn't sure what and that he was "minding his own business" when it happened. So the nurse put him in a room to wait for the doctor to see him, figuring it was not serious and did not need urgent care. Well, I show up to see him 3-4 hours later (it is really busy on new years day in the ED) and he has a blood stained nose that is very swollen. He tells me a similar story to what he told the nurse, and so the attending doc decides to get a CT scan of his face to rule out anything major. Well, a few hours later, the CT scan shows shrapnel from a bullet that is throughout his sinuses and underneath his skin! This man had been shot in the face! He should've been a trauma patient and seen immediately but instead waited 6 hours before he got attention! I don't know if this guy was trying to hide something or really had no idea he'd been shot in the face, but we were all grateful no important structures were damaged. Crazy, eh!
3. 90% of patients in the emergency department do not need to be in the ED. Period. Sadly, most of the patients in this ED either presented with strep throat, colds, headaches...things that they should've seen a family doctor for, or came in with stories of pain in order to get the narcotic pain meds that they were either addicted to or are going to sell on the street. The reality is there is a small part of our society that uses up a considerable amount of resources. They treat the ambulance as the big red taxi to the hospital to get their pills. They know they won't be turned away if they can't pay, so they come for anything and everything. They say the right buzz words and the ER doc is forced to order CT scans, lab tests etc that cost thousands of dollars in order to protect himself from the people who are trying to play the lottery and find a doc who "messes up" so they can sue for millions of dollars. It's a very sad and disheartening reality. I believe this is a big reason why medical costs have skyrocketed. That is all I want to say about politics.
4. Emergency Physicians surprisingly have very good lifestyles. Most work 18-10 hour shifts a month and get the rest of the month off. The average pay is 300k. They are contractors for the hospital and don't have to worry about starting an office and absorbing those associated costs. I loved working in the ED for the first 3 weeks of the rotation while working days, but absolutely hated it when I worked the overnight shift several times during my last week. That is one of the downsides with emergency medicine. Also, you will likely work a lot of nights, weekends and holidays. They have one of the highest burnout rates of any physician. It is a very high stress environment, especially at night.
5. The most exciting trauma: Seeing the skin and some facial muscles dangling from a man's face after he hit a tree driving a car under the influence of alcohol. He survived without any brain damage...it was pretty crazy. It was cool to see that no matter what the person did to get to the trauma room, they received the same great care.
I really enjoyed the rotation and strongly considered going into EM for a while, but for some of the reasons stated above have decided against it.
Sunday, January 24, 2010
Rotation #5 Pediatrics
Before I talk about my experience in peds, I gotta give a shout out to all Parents...it's a tough job! Keep up the good work! I also gotta give a shout out to all Pediatricians...it's also a tough job! And one I don't think i'll take, thank you very much. The ironic thing is, I really enjoyed my experience playing games with the little tykes as I examined them. I enjoyed Dr. Bowser(great name for a pediatrician don't you think? :)) and her love for the kids rubbed off onto me. I enjoyed the staff I worked with. I enjoyed the hours. So, I bet you're asking why I am not considering Pediatrics as my future career right now, right? Well, there are a couple of reasons but in a nutshell I was usually exhausted and sick of kids by the time I was finished at the end of each day...and I don't want that to affect how I treat my future kids. It takes a lot of energy to persuade those little ones to let you look in their mouth, ears and eyes. :) Also, after doing 6-7 well child checks my first afternoon, I was tired of doing them and listening to the laundry list of concerns parents had. I figure if I was already sick of doing them at that point, how would I feel about them in 5yrs, 10 yrs and especially 20 yrs down the road. Don't misunderstand me here though because I think parents should talk about ANY concerns they have with their pediatrician and I am happy to help any parent who reads this blog, but I just don't want to do that all day every day. Anyway, here are some of my observations about pediatrics:
1. Find a good Pediatrician. In my eyes, a good peds doc is one who helps a parent stay up to date on immunizations, guides them on what to expect in the next phase of the child's development, provides guidance and troubleshoots with parents about nutrition, sleep, hygiene and lifestyle habits, pays attention to detail and conducts thorough physical exams. Recognize that a pediatrician does not have copious amounts of time and may refer you to a counselor for behavioral issues or other services if need be.
2. Female Pediatricians vs. Male Pediatricians. Both of the ped's docs I worked with were females and they were superb by how they took care of the kids and how they patiently communicated with parents...which makes me wonder if female pediatricians are better suited for the job because of their natural ability to nurture and listen. I'm sure there are great male pediatricians...I just haven't met too many of them yet. :)
3. I struggled on occasion when I dealt with the sexually active or drug abusing 12-14 yr olds(or younger). It was so sad and frustrating to see them ruining their lives. I found it hard to have to act non-judgemental about their actions.
4. My preceptor tended to share with parents strategies that had worked in her personal life about raising her son which seemed to be widely accepted by parents. I knew what she was sharing was usually evidenced based but the way she was presenting it made her feel more like a caring friend going through the same experience giving sound advice rather than a "mighty doctor" looking down on her patient and spewing out the facts. I liked that and hope to incorporate it in my future practice in whatever field I end up in.
5. Call your pediatrician before going to the ER if you can. Most of the time, the pediatrician can do more for the child and save you the hassle(and the hours of waiting) of the ER if the child really doesn't need emergent care. They will likely work you in to be seen that day if your child needs to be seen. I would only take my child to the ER if they were less than a few months old and had a high fever, if they were seriously having trouble breathing(more than what a cough and congestion would cause), if they had been vomiting and had diarrhea for days and I was concerned about their dehydration level or if there was a severe injury and needed immediate attention or pain relief. This is not a comprehensive list.
6. If your child has a rash, consider if there are ANY recent changes in detergents, soaps, deodorants(teenagers), new clothes, environments, school rooms, new pets, etc, etc, and try to remove those agents before going to the doctor. You can try an over the counter steroid cream to help with the rash...or try a lamisil cream for possible fungal infections. If that doesn't work you'll probably need to see the doc to get a higher strength prescription cream because the rash is likely eczema or fungal. Of course if there is a fever or viral syndrome associated with the rash you should see the doctor either way. This is my random health tip of the rotation to you...at no charge! ;)
Have a great day and look forward to my some day in the future postings about my Emergency Medicine rotation I just completed, and of course my MARRIAGE!
1. Find a good Pediatrician. In my eyes, a good peds doc is one who helps a parent stay up to date on immunizations, guides them on what to expect in the next phase of the child's development, provides guidance and troubleshoots with parents about nutrition, sleep, hygiene and lifestyle habits, pays attention to detail and conducts thorough physical exams. Recognize that a pediatrician does not have copious amounts of time and may refer you to a counselor for behavioral issues or other services if need be.
2. Female Pediatricians vs. Male Pediatricians. Both of the ped's docs I worked with were females and they were superb by how they took care of the kids and how they patiently communicated with parents...which makes me wonder if female pediatricians are better suited for the job because of their natural ability to nurture and listen. I'm sure there are great male pediatricians...I just haven't met too many of them yet. :)
3. I struggled on occasion when I dealt with the sexually active or drug abusing 12-14 yr olds(or younger). It was so sad and frustrating to see them ruining their lives. I found it hard to have to act non-judgemental about their actions.
4. My preceptor tended to share with parents strategies that had worked in her personal life about raising her son which seemed to be widely accepted by parents. I knew what she was sharing was usually evidenced based but the way she was presenting it made her feel more like a caring friend going through the same experience giving sound advice rather than a "mighty doctor" looking down on her patient and spewing out the facts. I liked that and hope to incorporate it in my future practice in whatever field I end up in.
5. Call your pediatrician before going to the ER if you can. Most of the time, the pediatrician can do more for the child and save you the hassle(and the hours of waiting) of the ER if the child really doesn't need emergent care. They will likely work you in to be seen that day if your child needs to be seen. I would only take my child to the ER if they were less than a few months old and had a high fever, if they were seriously having trouble breathing(more than what a cough and congestion would cause), if they had been vomiting and had diarrhea for days and I was concerned about their dehydration level or if there was a severe injury and needed immediate attention or pain relief. This is not a comprehensive list.
6. If your child has a rash, consider if there are ANY recent changes in detergents, soaps, deodorants(teenagers), new clothes, environments, school rooms, new pets, etc, etc, and try to remove those agents before going to the doctor. You can try an over the counter steroid cream to help with the rash...or try a lamisil cream for possible fungal infections. If that doesn't work you'll probably need to see the doc to get a higher strength prescription cream because the rash is likely eczema or fungal. Of course if there is a fever or viral syndrome associated with the rash you should see the doctor either way. This is my random health tip of the rotation to you...at no charge! ;)
Have a great day and look forward to my some day in the future postings about my Emergency Medicine rotation I just completed, and of course my MARRIAGE!
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