So here’s my post about my latest shadowing experience. We’ll call this doctor Dr. I for privacy purposes. 🙂
This happened over a two day period. Dr. I was in her last week of residency when I shadowed her, so I got to see her last day and how she said goodbye to all her patients. It was a bittersweet moment for everyone, including myself since she had been such a big part of my hospital experience. Every doctor I’ve met has been fantastic and I wish to be like them in some way, but if I can be as caring and helpful to my patients like like Dr. I is I will be happy with the level of care I provide. Dr. I, if you ever read this, which I doubt, thank you for everything. 🙂
Okay, so on to the actual experience! I did about 11 hours worth of shadowing. Since she is a resident I can’t count it as accrual shadowing experience, so it will go on my application as patient exposure.
One of the patients we had had shingles. She knew what she had since it was her second time having it. We were in and put within minutes, which doesn’t harken very often when I shadow.
The second patient was a child who had persistent cough, about a month if I remember correctly. Dr. I let the parents know coughing isn’t necessarily a bad thing, that it’s just a reflex. She thought it was likely due to allergies. After a while of trying to convince the mum odd this, we moved on. We then talked about how she was almost certain that the parent wouldn’t listen to her instructions because she felt the parent didn’t trust her diagnosis. She then told me only about 60% of patients actually do what doctors tell them, so all you can do is reassure them and hope they’ll listen.
We also had a patient who had chronic pain and had come in because she had fallen and hit her head. Dr. I isn’t a fan of narcotics (neither am I) so it was a big hard to deal with. On the one hand you want the patient to be comfortable, but these drugs are dangerous. Your tolerance for them increase, but the toxicity curve doesn’t move. The more you take them, the more meds it takes to help your pain… and the closer you get to that curve. I found a diagram for it here Dose-Response Curve. In the end Dr. I let the patient know she was taking too many and that she wanted her to wean off of them a little bit.
I also saw a few cases of cellulitis! I’d never seen it before so it was really cool. Cellulitis is an infection of the soft tissue, that presents as a red area that is hot and swollen; more info here. Dr. I prescribed medication for it and also outlined the red area so the patient could see if it spread further or if it was receding (and the medicine was helping). After we saw the first patient with it Dr. I and I went back to her office so she could show me another case of cellulitis… in her cat! It was awesome! It’s always interesting to see what disease we share with other species!
At one point we had a patient who came in because she was experiencing some abdominal pain. While she examined the patient she poked the areas that hurt and then asked her to do sort of a sit up before poking those places again. The patient tensed up and Dr. I concluded her exam. I later asked her what she was feeling for and she said she was looking for masses, tenderness (lower or upper), guarding (which is the tensing up), and peritonitis. The guarding is important; when the patient tenses up, the muscles are protecting the organs. If the problem was internal, the patient wouldn’t feel pain when doing the sit up. However, since the pain was superficial, Dr. I discovered her pain was muscular. I think that was one of my favorite things to learn about that day. The patient also had a hernia, so I asked Dr. I what you do about those. She told me that the bigger the hernia, the less they worry about! She said it’s big enough for the bowel and blood vessels to go through it, so it gets some blood flow.
I asked Dr. I why she went into family practice. She said she went into med school wanting to be a neonatologist, but she later realized it was too specialized. She then thought about peds, then OB/GYN. However, she realized that after you cut the cord, that baby isn’t your patient anymore. She also said she wouldn’t like to do it every day; she loves it, but she wouldn’t love it if that’s all she did. She then chose family practice so she could do all of those things. She likes the variety. She is also doing a fellowship in OB so she can keep doing C-sections, which satisfy her liking for surgery without needing to be in an OR longer than an hour.
I also asked her if she could fire patients as a resident and she said you could. They are usually due to the clinic policy, like for no-shows, but that she doesn’t do it very often.
I also wanted to know what her stand on patients who didn’t vaccinate was. This was the most insightful conversation we had, so I’m glad I asked. She said that if you ban them from your practice you don’t get the chance to talk to them and ease their fears. If they are comfortable with you and respect your opinion as a doctor, they might change their minds later on. She so said you don’t want all the crazies in one room (aka all the anti-vaxers in one physician’s office). That comment made me laugh. 🙂 The other side of that argument is, if they don’t trust you on something that science indicates is effective, why would they listen to you when you say something else? If later on they need antibiotics, will they listen to you and take them? Or would they be against that too? At that point you have to ask the patient if you two are a good fit and perhaps have the patient find another doctor.
I also got a chance to shadow another resident while Dr. I waited for more patients to come in. It was a 6 month old baby and she came in for a well check. Dr. C let me look through one of the instruments (I’m afraid I don’t know the name of) and look at the red-eye reflex. It was so cool! You basically look for that red-eye that shows up in pictures. If it appears red-ish it means the eyes are healthy. If they’re not, they’ll present as white, which could indicate a tumor.
The second day was similar. There was a patient with no insurance who needed a colonoscopy; he would have bowel moments but blood would be the only thing that would be passed. He had had this problem for six years. It was upsetting because the procedure was so expensive without insurance that Dr. I was almost positive he wouldn’t get it done, which is the reason he didn’t do it three years ago. Dr. I set him up with the financial assistance department and said all we could do is hope for the best. He did have hemorrhoids so she treated him for those and gave him a stool softener so they wouldn’t get worse.
At one point we had a patient who had to decide if physical therapy or surgery was the right course of action. He decided that he would like to try physical therapy first since he didn’t like surgery, and Dr. I agreed with him. She said that sometimes spinal surgeries don’t completely fix the problem and they can lead to even more surgeries. That was another interesting thing I learned about that I probably never would have thought to ask!
We also had a child come in due to cellulitis on his toe. It had been going on for a while and the mum was putting neosporin on it constantly. Turns out that the neosporin was what was causing it since the child had developed an allergy to it. Dr. I’s attending explained to the patient’s mum that neosporin had an ingredient that when used too often leads to allergic reactions; she needed to stop using it in order for his toe to get better!
The last thing I asked Dr. I was what she wished she knew before starting residency. She told me that medicine felt a lot with business (insurance, marketing yourself to the patient so they would continue to see you, etc.) and that she wished she had taken a course on business management during college. She also said if you wanted to travel (with my kids) that I have to do it before med school; you don’t have time after that. You can wait until you graduate but you can’t take off to much time since your patients need you and they don’t want a doctor who will be gone 6 months. It was good advice, but I did tell her I was already 24 and I probably wouldn’t do it since I felt I had already lost enough time not knowing what I wanted to do.
In the end she set me up with another doctor so I can shadow him this summer. I gave her a thank you card but also told her how thankful I was for everything she’d done for me (since it wouldn’t fit in the card). She hugged me like 5 times and told me that although she’d be on the other side of the country to call her with any questions about med school and my application. She was very sweet about it and even told me she thought admission committees would love me and that I’d be accepted.
It was a great experience. I’m very lucky I was able to meet such a caring and ambitious doctor. If I can be half the doctor she is I would be happy.
Thanks for reading and I hope you found this post insightful and interesting. 🙂 I’ll be getting in touch with the doctor Dr. I set me up to shadow some more, so I’ll let you all know how that goes.
Wish me luck!