Yesterday I had my standardized patient encounters for both the cardiovascular exam as well as another ‘pulled-from-the-bag’ exam –> turned out they had the flu. i suggested antibiotics, uh, shannon….its a virus!
I always wonder what they think as they sit there and let us pretend to know what we’re doing. Of course I suggested plenty of fluids, rest, stay away from EtOH, smoking etc… but those antibiotics I was going to prescribe them, those were the mainstay of my treatment. In those moments you have to seem confident so as to not fail miserably at the encounter, so whatever comes out of my mouth-I act like its true. (yes, i know its not what you do to treat the flu)
We’ve come to the point now where we’re supposed to be able to come up with 3 differential diagnoses and a plan on how to educate the patient and continue with a treatment…do they know that just over a year and a half ago I was a nanny and my solution to any sort of illness or issue was to ask my mom? Too bad we can’t make calls while in the exam room…
Last year in one of my patient encounters I was taking the patient’s vital signs, but didn’t have a watch. So, obviously, as any good doctor would, I put my hand behind her back so she wouldn’t see my lack of timing device as I took her pulse and respiratory rate-success! Trust me, I’ve learned from all of these things. Thank goodness we have all of these supervised times for practice to make really stupid mistakes–thankful for myself and thankful for my patients.
On to the CV exam…I think my patient was having an MI (Myocardial Infarction aka heart attack). AGh! Of course, it was a woman, who, in general, present with a wider spectrum of symptoms. But she had SOB [shortness of breath], chest pain that radiated, family history, etc… I went through the history swiftly, didn’t forget any part of the exam except for palpation of her back, finished with time to spare and closed the encounter with letting her know my plan (hospital –> ecg –> cardiac enzymes –> look at results), but this being my first CV exam…I did forget ONE thing: to tell the patient what I thought she had! I suggested all of these tests and forgot to tell her why, ce la vie.
Today I focus on the normal cardiac cycle. Lots of graphs with curved lines that don’t make a lot of inherent sense to me–going to take a lot of brain power, so I’ll probably have to stock up on my sweet supply 🙂