Hi Danielle,
The beauty of medicine is that you tailor your fact-finding to the situation. When a patient presents in ER, you probably would not have time to do a thorough history and physical. We do what is called an AMPLE history and focused physical exam. (Allergies, Medications, Past medical/surgical , Last Meal, Events preceeding injury/illness). Later on, you can fill in the details when the patient is better or get the details from an old chart or family member (History obtained through medical records or family member is noted on the history sheet.
With practice, you will learn to get everything in one swoop. For example, I do my ROS while I am examining the patient. I start at the head and move downward so I am talking and examining at the same time. This skill comes with practice though. Since you are just getting started, do your H & P the same way every time until you get a style. Arn’t you having a great time?
Natalie 
Diane, another great thing about being a student is that you aren’t expected to be quick at getting all this information. And be prepared to feel like you have done an exhaustive interview, only to have your preceptor ask you ONE question about your patient that will be the thing you did NOT ask. Happens to all of us.
I learned a great trick from a family practice doc my third year: ask early about medications they’re on. It’ll give you instant clues about at least some of their past medical history. (e.g. hypertension, diabetes, high cholesterol). Never assume - you’ll want to say, “You take HCTZ, is that because you’ve had high blood pressure in the past?” But it can be a nifty shortcut.
As Nat said, start out learning the pattern and much later on you’ll figure out the stuff you can cut out. This will also be true when you start rotations and present patients - initially you give the details in a highly stylized format; eventually you learn what things are extraneous.
Mary
Who’s Diane? Im Danielle! I did have an English teacher all through high school who called me Nicole HAHA!
Danielle
Quote:
Who’s Diane? Im Danielle! I did have an English teacher all through high school who called me Nicole HAHA!
Danielle
Hey Danielle,
Just having a “Senior Moment”. Getting more senior moments these days.
Natalie
Quote:
Who’s Diane? Im Danielle! I did have an English teacher all through high school who called me Nicole HAHA!
Danielle
We not-Diane’s have to stick together! My poor father has called my Diane almost all my life. (My sister’s name IS Diane, so it’s not as bad as it sounds.) Now he calls me Melinda, Diane’s daughter’s name, instead.
sorry Diane, um, I mean, Danielle. I refer to my youngest sister by my daughter’s name fairly regularly which amuses both of them no end.
Mary
Week 5 of medical school has been the busiest week by far!! I am really starting to feel like I am running the proverbial marathon, but I am still having fun.
On Monday we had the 2nd exam of med school in Cell Biology. Cell Biology is a 1 credit hour course and our midterm consisted of 25 multiple choice questions. I only got 2 wrong, so I did well, but about 20 people got 100% correct so I didn’t rank as high as I did with the Anatomy exam 2 weeks ago. Although, I am not worried too much about this class! Afterwards, the professor took us all out to Ben & Jerry’s and bought our whole class ice creams. It was great!! I wish this professor would teach all of our classes.
Tuesday evening, I went to the Family Medicine Fall Dinner and interest group meeting and I have to say that I was totally impressed. I have been to the pediatrics interest group meeting and other clubs and it’s basically senior students and a pizza lunch. Afterwards, you sign up for a list serve. At the FM dinner we had about 10 resdients from the program, several faculty members, the residency program director and the chair of the department. All of theses people came out to talk about Family Medicine to new medical students. At first I thought it must be a sales pitch because it’s hard to recruit people to this specialty. Then I sat and talked with some of the faculty and residents and they totally LOVE their jobs! When I realized their philosophy on birth is similar to mine, I was hooked. Additionally, I found out that you can still specialize and do research in FM.
Wednesday we interviewed our first simulated patients in the Intro to Clinical Medicine class. It was a lot harder than I thought it was going to be. Patients simply do not answer your questions as categorically as you ask them. While you ask them about their chief complaint (which usually comes at the beginning), you may get a long answer with tidbits relevant to Social History (which usually goes at the end) Additionally, pauses in conversation can be very hard to handle when you are thinking of the next question to ask. It was an eye-opener, but I definitely feel better about how to do it than before the experience. After classes, I went to a staff meeting at my old job (I still sorta teach there, but I am not doing any classes until the summer)
Thursday was one of those days where nothing seems to go right. Here is an exerpt from and email I sent to my husband when I got home that day:
Hey honey!
What a day!! I am POOPED. I picked up my coffee by the lid this morning and got coffee ALL over me. Luckily I was wearing shorts…
I went to the gym to work out and this fat old guy hit on my while I was doing my sit ups, YUCK! He asked me if I worked at the university and when I said I was a student he said I looked older than most of the girls that come in there! What an ass!
On the way back to Berryhill I dropped my One Card (my pass to everything) and I couldn’t find it ;-(
I am going to get ready for tomorrow and then I am going to bed.
By Thursday afternoon, I was sooo exhausted, but I had to prepare for Friday’s anatomy lab.
When I got home Friday, I began studying for the Molecular Biology and Genetics midterm for Monday. I went out Friday night to a small local club called Players. The med school reserved the place from 9-11 pm and bought us keg. It was the annual 70’s bash!! I had a great time seeing all my classmates dressed up and having a great time.
This week promises to be more low key than last week (other than the midterm on Monday). I have scheduled less extracurricular events and I have decided not to run for any student government positions (the elections are next week!) On Monday, I am attending a seminar on how to take vitals and I am really looking forward to that. Next weekend I will be studying for the second Anatomy and Embryology unit exam (woohoo)!! The good news is that there won’t be anymore tests for 2 weeks after that one…WHEW!
Danielle Inman
MS-1, UNC-SOM
Hey OPMer’s!! More about my experiences below:
There is something special about the milestone of 6 weeks. In relationships it’s when you just start to feel comfortable with a new special someone. In a new job, you start to get the hang of things and do not need as much supervision. In a new home, you finally have everything just the way you want it. In medical school, I think it’s when you really start to harmonize with the rhythm of the task at hand. It’s still a lot, no doubt about it, but it is really starting to come together for me.
Monday, I took my 3rd test in 3 weeks. The Molecular Biology and Genetics midterm was harder than I thought it was going to be, but I passed with and 84%; a respectable pass. After the exam I learned how to use my stethescope and BP cuff. I am still not sure what I am listening for, but I am told next semester we will be taught the signifigance of certain sounds. For now, I only get to do vitals. Walk before fly, grasshopper!
The rest of the week, I was gearing up for the next Anatomy exam scheduled for tomorrow. The exam will cover the thorax and the abdomen. I spent most of the weekend, up to my ears in guts, HAHA. I swear, Saturday night, I dreamt about the colon all night. That can’t be normal!
Lots of cool things are happening in the next week that I am very excited about. After the Anatomy exam, 2 of my classmates and I are going to visit a patient and talk with her about the social aspects of her illness. It’s part of our final project for the Medicine and Society class. We will visit and talk with her for about 2 hours and then visit her again later in the fall. Each of us will write a 10 page paper on our observations.
On Tuesday, I will be learning how to draw blood. I am really excited about that too and that probably isn’t normal either!!
Then on Saturday, I will receive my white coat in front of my whole family as I take the student version of the Hippocratic oath!! I have been waiting for this day for 3 years and I am in utter disbelief that it is only 6 days away. I will very likely get teary-eyed when I look over at my very proud parents and husband. At first, I was disappointed that we didn’t get our white coats during the first week like other schools do, but after 6 weeks, I kinda feel like I have earned it. It’s like I had to get over that first little hump adjusting to life as a med student and this is my little reward. A succinct reminder of why I am putting myself through all of this and a little push to get through the last half of the semester.
BTW, the weather here in Chapel Hill has been absolutely magnificant this week. There is a saying that goes, “God painted the sky Carolina Blue.” If you have ever spent the fall in Chapel Hill, you would be a believer. The leaves are JUST starting to hint at changing their colors and in a couple of weeks, the campus will be in it’s full fall glory. The hot, humid summers are so worth the fall time weather here. I just LOVE this time of year!
Danielle Inman
MS-1, UNC-SOM
Wow Danielle, what a great post. I’m glad to hear you’re doing so well with school. It must be nice to live in a pretty place! 
Best of luck, and congrats!!!
Know what? I was reading the “Gunner” thread and all of sudden I feel kinda stupid. I have been posting my exam scores of my exams in my posts.
I was doing it because I feel like if I can get mid-high range scores on my exams, then anyone can. I also thought that people may want to know that the exams are not so terribly difficult (if you study!).
Having the p/f system means that P=MD and I think that’s fabulous. Also, it’s true that patients do not care what your rank is or what you scored on your first year exams. However, for me, and I’ll hazard to guess that for many people, doing better than passing means on a personal level, I am succeeding.
I am not a gunner, but when I slay an exam (oh my gosh! A med school exam!) I feel pretty darn good about it. Additionally, while p=MD, an internal high rank means more opportunity for scholarships later in medical school. Who doesn’t want that?
That having been said, I’ll not bore anyone further with my scores. I will give you the average and report if I slayed it respectably or honorably 
Thanks for putting up with my borderline gunnerisms as I promise to celebrate internally.
Danielle
MS-1, UNC-SOM
I have to disagree that if you study exams are easy…I studied my ass off for my first gross exam and it was extremely difficult because most of our questions are clinical questions with huge paragraphs to wade through. I am not complaining though bc it is obvious that this method works based on our average USMLE.
Ok, I’ll admit it I am a gunner… out of the closet. I love medical school! I love the challenge, I love learning and I love it that I am doing well. I am a giant NERD
However, I am sorry that your first exam was difficult. I know it will get better for you when you get into your groove. You got into Mayo for Pete’s sake! You obviously have the skills.
Danielle
Hmmmmm?
Quote:
Ok, I’ll admit it I am a gunner… out of the closet. I love medical school! I love the challenge, I love learning and I love it that I am doing well. I am a giant NERD
I personally don’t think there’s anything wrong with being the type of “gunner” you describe. You’re proud of yourself and I think most people know the difference between being proud of oneself and bragging.
On another note, I’ve known of 3 nontraditional students in recent years that left the UNC’s med school, so I’m wondering if the situation or should I say the “attitude” toward nontraditional students has changed over the years.
There were a couple of ups and downs this week. Monday, I woke up and it was pouring down rain (Ivan or Jeanne remnants, I think) painting the day gray and dark. I arrived at school to take the second anatomy exam covering the abdomen and thorax. Our class had 20 days to prepare for this exam and it was no less extensive than the first exam. During those 20 days we also had a Cell Biology Midterm, a Molecular Biology & Genetics midterm and a 6 page paper due. I am pleased to report that I have passed everything, although I did not do as well on the anatomy exam as I had hoped.
After the exam, during a welcome repreive from the rain, two of my classmates and I traveled 40 miles to visit a patient recovering from cancer in her home. We sat and talked with her for about 2 hours about her experience with healthcare during her childhood and then during her most recent encounter. It was really awesome talking to her. She described her life as a young girl growing up on a farm back when doctors used to make housecalls in their horse and buggy. All they had for entertainment back then was a radio and of course their neighbors. I can’t even imagine what that was like! Afterwards she served us an apple pie that she baked and ice cream. We will visit her again in about a month and I am really looking forward to talking with her.
On Tuesday, I went to a phlebotomy workshop and I successfully drew blood from my partner! It was exciting to finally learn a technical skill of the trade. The instructor offered us the opportunity to work in the clinic on real patients should we like more experience. Now I just need to find the time to do it!!
This week we started the Pelvis and Lower Limb unit in anatomy and I have to say that Thursday’s lab was very surreal for me. I won’t gross anyone out with the details other than our cadaver is now in 3 pieces. Talk about the challenge of distancing yourself!!
On a lighter note, my family arrived in town on Friday night to spend the weekend with me and to attend Family Day and the Whitecoat ceremony. It was so nice to be able to spend time with them and out of the books. My family really enjoyed spending the day at the school and seeing where I spend my time day in and day out. The ceremony was really great! My husband and father were moving about with the cameras to get the best angles to take pictures. All my classmates look so professional in their new white coats. I could barely contain my tears of happiness as we were reading the student version of the hippocratic oath (see the post below). Afterwards, we went out to dinner to celebrate.
There are no exams this week! Instead we will spend Monday, Wednesday and Friday working on a motor vehicle accident case for “Problem Based Learning Week”. This exercise is a collaborative effort an the part all of the departments involved in our education to tie together all we have learned so far. I can only imagine what it will be like, but it looks like fun. The really cool part is that I understand the readings for the case because of material I have learned so far, so something is definitely sticking!
Danielle
MS-1, UNC-SOM
This is the student version of the hippcratic oath I took with my classmates on Saturday at our White Coat Ceremony:
I acknowledge and accept the privileges and responsibilities given to me today as a physician-in-training and dedicate myself to learning to provide care to those in need.
I will approach all aspects of my education with honesty and integrity, embracing opportunities to learn from patients, teachers, and colleagues. The diversity of their experiences, cultures, and beliefs will enrich my education and my ability to care for patients. When I feel unprepared for new responsibilities, I will acknowledge my limitations and seek guidance.
I will respect the humanity, rights, and decisions of all patients and will attend to them with compassion and without bias. I will maintain patient confidentiality and will be tactful in my words and actions. I will not forget that there is an art to medicine as well as a science and that warmth, sympathy and understanding are integral to patient care.
I recognize the privleges afforded me as a physician-in-training and promise not to abuse them. I will strive to earn the trust my patients place in me and the respect that society places upon my profession. As a student, I will seek to acquire the knowledge and the skills needed for individual patient care, the capacity to prevent illness, and the means to improve my community’s health standards.
As I accept these new responsibilities, I will not forget the importance of my own health and well-being. I will continue to value my relationships with those who have supported me in the past and those who will share my future.
Knowing my own limitations and those of medicine, I commit myself to a lifelong journey of learning how to cure, to relieve, and to comfort with humility and compassion.
D
Hey everyone! I hope you are enjoying the fall.
The past 2 weeks have been quite a challenge!! Fall break started Wednesday afternoon and I think I have slept about 24 of the past 48 hours. I was so tired mentally, physically and emotionally. Three days of the week before last were spent in a PBL of a trauma patient. Each day started at 8am. The first hour and a half was a lecture format, then small groups of 6 would assemble (each person being a different specialist). In our small groups we were to determine questions we would like to ask experts. Each “specialist” would go to another meeting of 30-35 ppl to talk to a real specialist. Afterwards, the smaller groups would reassemble and write up a treatment plan. We would break for an hour for lunch and then reassemble as a large group to present our plans and hear from the expert panel. Day 1 was the initial ER encounter and stabilization of life threatening wounds and I got to play the trauma surgeon. Day 2 was the intensive care portion of the patient’s recovery and I was the urologist. Day 3 was the rehabilitation portion of recovery and I was the physologist.
The whole experience was a great deal of fun and I learned so much about trauma care. Additional learning points were also added to the case. For example, our patient was an illegal alien whose first language was not English AND he was a Jahovis Witness. This meant that he was eternally damned because of the blood we gave him in the ER. Also, the family was without insurance so we discussed the implications of that in great detail. Finally, we talked about urological/sexual issues for a teenager with his injuries. I had a blast!
The only problem with the whole thing was that it was not “required” nor did it contribute to our grades. By the end of the 3rd day only 30 of us (out of 160) were left. Our Biochemistry course director, who planned the whole week, was very disappointed and sent an email to our class expressing his disappointment. I felt obliged to go for several reasons even though I would have much rather spent those days studying for the BIOCHEM midterm. One, they had been planning that week for over a year, two, the experts (i.e. the chief of surgery) spent nearly a whole day with us and finally, there are at least 2000 applicants from last year who would give anything to sit where I was sitting, required or not!
However, this week we had our Cell Biology final on Monday and our Biochemistry midterm on Wednesday. Additionally, because I was gearing up for these exams, I am now 5 lectures behind in Anatomy. Let’s just say that I was miserable last weekend. Cell Biology is done with a respectable pass, but Biochem is a narrow pass. That grade has made me very nervous. I plan on spending extra time with this class the rest of the semester.
Tomorrow, I am going to the NC State Fair to help out with the North Carolina Medical Society (NCMS) booth. I will be teaching kids about healthy eating, leading group excercise and painting faces. It should be fun and I am looking forward to being outside. On Sunday, I am leaving Chapel Hill for my community week. I am working in a small coastal town called Belhaven, NC where I will spend the week in a Family Medicine office practicing my interview skills and learning more about that particular community. I will return 4 more times during the next 2 years, so I am hoping I have a nice preceptor!
Every evening, I will be catching up on Anatomy so I hope to be back on track when I return to classes next week. Immunology starts next Monday and there are only 7 more weeks left of the semester!! I can hardly believe how quickly it’s gone by…
Danielle Inman,
MS-1, UNC-SOM
Hey everyone!
I feel like I am closer to being a doctor today than I was one week ago. On Sunday I left for my week in the community. After a 3 hour drive, I arrived in Belhaven, NC, found the apartment I was staying in and prepared myself for a week of student doctoring. I arrived at Belhaven Family practice at 9am on Monday and spent most of the morning following and observing my preceptor. During lunch, I review my goals for the week with my preceptor; to practice interview skills, complete at least one full history and to make observations about the community and access to health care. My preceptor and I hit it off from the very first conversation so I am pleased to say we had a productive week. During Monday afternoon, I continued with shadowing.
Tuesday morning, I completed a full history on a patient who was admitted for chest pain and was being tranferred to a larger hospital for a more complete work-up. Afterwards, I followed a full-term pregnant teenager during a non-stress test. When I returned to the clinic a pharm rep had a delicious chicken salad lunch waiting for the staff. On Wednesday, I pre-interviewed about half of the patients and then did “hallway” presentations to the doctor. Thursday was a half-day and I spent the morning with the office staff to learn about what their jobs were. The doctor took me to lunch and I spent the rest of the afternoon walking or driving around the town. Friday was more pre-interviewing and presenting.
Every patient was so different! Even though many presented with common diseases and problems each had a unique set of issues and different ways of describing their symptoms. I was amazed at the amount of information that some were willing to share with me. Some would talk endlessly and others needed a little small talk before they would open up. Many were in situations that tore my heart out and I had to fight back tears. Still others would frustrate me with their ambivalence toward their situation and apparent lack of interest to help themselves. After each encounter, the doctor would explain his diagnosis and would encourage me to think about why he asked certain questions. Many of the clinical correlations I have been learning in my classes came up during the week and I really enjoyed seeing these things in the “flesh”.
One of the neatest things about my experience was witnessing a small town environment. I am a big-city girl and my only exposure to small towns has literally been from watching television and movies. My preceptor has been practicing in Belhaven for nearly 15 years. It was apparent to me as we were eating our lunch on Thursday that he probably knew or met everyone in that town. People would come up to him in the middle of the meal, shake his hand and then tell him about a problem they were having or would gossip a little. “Everyone knows everyone here” he told me.
The only thing I wish had been different about last week was that I was staying alone and I was a little freaked out. The office manager of the practice said that if I wanted to stay with her when I returned that I was welcome. Small-town southern hospitality has a way of growing on you. I am really looking forward to returning and developing my clinical skills.
This week it’s back to reality. I was able to catch up in anatomy and, believe it or not, get a little ahead! Next Monday is the 3rd exam covering the pelvis and lower limb. I am counting down to winter break…
Danielle Inman
MS-1, UNC-SOM
I caught a nasty little bug during my community week and spent most of last week fighting it. Ambiguous pharyngitis - or severe sore throat of unknown viral origin. I went to the doctor on Monday and was negative for Strep A. I stayed out of school all day Wednesday and half a day on Thursday. Still suffering on Thursday I went back to the doctor to find out I did not have mono or menengitis. There was a menengitis scare here in Chapel Hill over the weekend so needless to say, I was relieved on that note. By Friday, I was on the mend.
Immunology started last week and the first lecture was on complement. For those of you who have never had Immunology, complement is a complicated little pathway and a brutal way to start a new class. I had to miss 2 lectures of Immunology and 2 lectures of Biochemistry this week because I was so sick. The rest of the time, I was studying for the Anatomy and Embryology exam that I took today covering the pelvis and lower limb. I passed, but for the amount of time I spent studying for that beast, I feel like I should have done a lot better. Last week was a BAD time to be sick!! I spent this afternoon organizing myself and getting ready for the last lap of semester 1. There is a light at the end of the tunnel and I can almost see it!!
This week we start the head and neck unit of anatomy and thankfully the last. Don’t get me wrong anatomy is a beautiful science and I really love the subject matter, but exams and the pace make it difficult to enjoy at times. Tommorrow’s lab covers the regions of the anterior neck and from the looks of it that tiny region of the body is incredibly complicated.
On Wednesday night I am sitting on a panel of medical students for the pre-med honor society of the undergraduate university. It’s hard to believe I was in their shoes just a short time ago. It seems like eons! It’s impossible to imagine what medical school is like until you have been there no matter how many people you talk to. I never dreamed how delicate the balance is and something as simple as a cold can throw it out of whack. I would do it all over again though because I am so truly happy.
Saturday, I will spend the day in a rural community working with a student run clinic. It’s a good thing I signed up for it. I had to miss my Intro to Clinic Medicine class this week and even though I had an excused absence, I have to make up for it by writing up a patient encounter. Hopefully, on Saturday, I will find a patient I can interview and get that taken care of.
The genetics final is 2 weeks away and it’s not cumulative, so hopefully the load will lighten a little. Until then, 7 weeks and counting…
Hey OPMer’s
What a great week!! This past weekend was the first weekend since the 2nd week of school that I have NOT had an exam on Monday. I was so relaxed this weekend and it was GREAT!! I was able to clean my apartment, organize my books and notes and spend time with my husband. I saw the movie The Grudge on Friday afternoon. Dumb! It reminded me of the Ring. Ring Two is coming out in the spring and I am definitely going to see that.
Saturday, I spent the day in Whitaker, NC at our free student run clinic. I followed around a 3rd-year student and together, we worked up our patients and presented them to the physician. I was utterly amazed at how much the 3rd-year knew in terms of disease and diagnosis. I have A LOT to learn. All of the patients of this clinic are poor and we provide all of their healthcare. The clinic is actually set up in a church. The congregational area is the waiting room, the kitchen is the lab and the bathrooms and room where the ministers get dressed are the exam rooms. We bring all the lab supplies and diagnostic tools and the local coordinator of the clinic arranges the church and keeps our charts. This was definitely a high yield clinical learning experience for me. I hope I will have the time to participate again. It’s run once a month, but because I ALWAYS have exams on Mondays (grumble, grumble), it’s hard to justify getting away. Next month’s clinic is right before the Anatomy final! BUT, January and February might work out.
This week I started interviewing mentors for long-term research projects. I interviewed someone today in the Fertility and Endocrinology department. They have a few ideas for me that would enable me to publish. That would be cool except most of the ideas are bench work in the lab. I had a less than ideal experience working in a lab as a pre-med and I get a sour taste in my mouth when I think of entering that environment again. Later this week I am interviewing a more clinically focused investigator. I think either experience will be rewarding, and I am excited to get started on a project.
The rest of the week I am going to be up to my ears studying for the genetics final (YES, next Monday!) and staying on top of head & neck strctures. Six more weeks to go…
Danielle Inman
UNC-SOM, MS-1