Being one-on-one with my preceptor is awesome in so many ways. I get to have her undivided attention when she’s teaching, I get to interact with every single patient, and I can ask her a multitude of questions without judgement from another student 🙂 and without them taking my time!
The down side, however, is that I have to hold my tongue a bit. The unfortunate truth is that I can’t just tell her everything I think about a patient, my personal experience, or that something we’ve said might be wrong etc…not that I can do that with any preceptor, but there is a level of conversation when you have several people as opposed to you and your preceptor.
For instance, I’ve had digestive issues my entire life (IBS, woot!) and what finally helped me get control of my symptoms: dietician! When I took the time after undergrad to really focus my time and energy on my diet I quickly figured out how to alter my pain, discomfort and the overall hassle of IBS. Of course as soon as medical school started and my stress level went up…well…not as well controlled, but you get the point.
So yesterday there was a patient that presented with pain from IBS and diarrhea that was causing him to stay home and wear diapers when he had to leave the house. Of course, this is awful and he needed help. I was pretty shocked when there was absolutely not talk of diet. I’m not all roses about our medical system and I know that medical schools on average don’t train doctors in diet. I also know that insurances (like medi-medi or low-income insurances) often times won’t cover a dietician visit for anything other than Diabetes management (and often times that is 1 visit). I also know that it takes time to evaluate your diet — and this patient in particular was extremely overwhelmed with their life and taking care of their partner who had several medical problems.
When I asked my preceptor if she had already been given counseling on how a dietician could help…she basically asserted that she wasn’t sure a dietician could help an IBS patient. Hm…are you sure? I just feel like I’m doing a diservice to the patient when I don’t offer every possible solution. I know that a lot of people won’t take it, I know that a lot of people want to walk away from a visit with a medication to feel like they’ve been helped. And I know that it’s our responsibility to help them how we can — for low income patients that might be managing IBS w meds that are only 4 dollars at some stores VS a dietician visit that may cost hundreds in the long run. I just don’t know how to become comfortable in all of this.
This has been my challenge since rotations have started. I’ve printed out pamphlets, phone numbers, addresses, and many resources for patients that the hospital or physician doesn’t have the time to provide. I’ve wondered what else we could do without thinking…will the patient appreciate this or listen to this? I know some of my efforts have been a waste of time, but I also know that it is sometimes the only extra help they get. That sometimes patients may feel desperate and will make any effort possible when the conventional methods have fallen short.
This is why I’ve been suggesting peanut oil when appropriate. What?! Well…peanut oil is a natural topical anti-inflammatant. For those patients that have unrelenting pain in their joints and the meds, steroid injections and PT aren’t helping…sometimes I simply suggest it. Who knows, it might help. **side note, this is a suggestion that one of my amazing mentors and faculty members on campus has made me aware of.
On another note, old patients are the best. I think geriatrics is a top runner for my specialty. Yesterday I was treating an older patient for neck pain. I was stood up, treating the neck and upper back. I spent about 10-15 minutes with her and when I was done I asked her if she felt better…she said, ‘why didn’t you do more?’ lol
Today is a half day, excited and thankful for the opportunity to learn from patients and my awesome preceptor.