I could do this better (and other thoughts)

As yesterday was my second day at the clinic, I walked in not knowing for sure what I was supposed to be doing.  When I asked my director, she responded, "What do you want to do?"  Thanks.  I'd like to see patients please, but the manner of doing so doesn't matter so much.  She informed me that I could follow attendings, follow students, see patients on my own, pretty much whatever.  Again, not so helpful.  I mean, I can be proactive and all, but it was my second day and a little direction just to clarify to everyone else what I was there for might have been helpful.  Anyway, I took charge and immediately turned to the other female med student (who was getting up to see her first patient of the day) to ask if I could tag along.  I did, and we saw a couple of patients together.  On the third try, I grabbed the info to enter into the growth chart, and she asked if I wanted to do the work on this one.  And so, I did.  History and physical for an 18-month old well child check-up (aka a "shots visit").  And I wrote the note (with some help) and I presented it to the attending for check-out, and it all went pretty ok.  I felt good about it.  I also felt good about the fact that I am better at taking a history and talking to parents like they are people and not just drones than most of the other students I'm working with.  

After that patient, we went and had lunch, and I resolved that when I returned in the afternoon I would make an effort to see a patient or two on my own.  Unfortunately, there were very few patients scheduled for after lunch, and the other students/residents grabbed the first few up.  But then!   A patient!  And no one else was around!  I grabbed the chart, saw that it was a well-baby check up (easy to do, something I know), and sat down to do the growth charts and whatnot.  At that point, I realized that this patient's name seemed Hispanic in origin, and I looked at previous info to see that, indeed, the doctor they had seen previously was one of our attendings who speaks fluent Spanish.  Being an intelligent person and not wanting to jump to conclusions, I went to the room, knocked on the door, and asked the parents if they spoke English.  Apparently they did speak some, but I decided to double-check with the doctor.  She was busy, but essentially told me to get the physical and any info I could, and she would come later to help with the interview.  Awesome!  Unfortunately, another doctor standing with her (who hadn't been in that morning) stuck her head in to say, "She's not allowed to see people by herself.  Send another student."  Not awesome!!!

Now, I know that Dr. A this morning informed me that I could see patients if I want.  And Dr. B wasn't around to hear that and was pretty much going on the information she had yesterday, which was that I was supposed to shadow.  But still, it was so frustrating when all I wanted to do was take a history.  Alas, I am not one with balls enough to argue with superior attendings, and so I dutifully went with another student, whose history-taking skills seemed incredibly subpar.  No offense to this person, but he just...I don't know, just kind of went through the motions.  I mean, I know these guys have been doing this for a year now, and I know they're probably burned out majorly, and I know they're not interested in pediatrics as a specialty, but you'd think they'd at least talk to the parents with some level of confidence, even if they're faking it.  Just saying.  Anyway, he took the history with a little help from me (since Mom did speak really good English) and then let me do the physical, which was fun.  9 month old babies are hilarious.  We presented to Dr. Spanish and she came in and answered any questions the parents had that they couldn't articulate as well in English.  

The rest of my afternoon was spent learning about diagnosing and treating asthma, since we didn't have any patients.  It was actually really informative and fun, and I felt like I really learned something about medicine.  Hooray!

Other highlights:

• A mom who brought in her baby because he "just didn't look right."  Now, I know that parents know their kids best, but really, we're pretty sure she just fed the kid too much and he was feeling too full. 
  
• Watching one of my fellow students remove sutures from the finger of a really smart elementary-school aged kid, who commented on the whole process throughout. :-D
• Doing a well-child check on a young kid whose entire family came with to the visit--mom, dad, and three very young brothers and sisters who decided that my history would be the perfect time to start screaming and fighting.  It was actually pretty hilarious.