Well, I just got home after finishing my first week of rotations with a family medicine doctor. I still have hospital morning report tomorrow and some research to do on malabsorption disorders and treatments, but my time with the doctor is finished for this week.
AND what a week it’s been!! I have absolutely loved every minute of it. When I introduced myself to my preceptor a few weeks ago, he said I would probably spend the first week or two just ‘kind of’ following him around and getting used to how things are done. Well, let me tell you what happened. By the third patient Monday, I was going in and doing the histories and presenting them to him. By Tuesday, I was beginning to add the physical exam. And by the end of the day today, I have been doing physicals, exams, assessments (diagnoses), and treatment plans, as well as writing the prescription orders and writing the orders for any lab tests that might be beneficial. I am writing SOAP notes, or at least parts of soap notes, which he verifies and confirms.(He may still write the plan part while I write the prescriptions or lab requests.)
I have done prostate exams, mini-mental status exams, review of systems, etc. I have dealt with COPD, hypertension, diabetes, lupus, anxiety, strep throat, acute abdomens, etc. I have done physicals for public employees. I have diagnosed and treated musculoskeletal problems using OMT. Of course, this is all done under the physician’s observations, supervision, and/or re-examination.
I have examined children, teenagers, young adults, middle age adults, and geriatric patients. Not one of them has balked or complained about a medical student doing so much of the exam.
WOW!!! What a week. Can’t wait for Monday to get here! I couldn’t have had a better first week as a third year medical student just beginning rotations. 
WOW! seems like an understatement. What a first week!
I am so happy for you. Your post made me smile and a little bit jealous. I can’t wait to be in your shoes next year!!
DRD
It’s so exciting! No wonder you cannot wait until Monday.
I’m sure you’ll enjoy the following week(s) even more!
Kasia
Way to go, Linda! I am not surprised!
Week 2 of family med I rotation is now finished and it was another interesting week for me. I was able to freeze off some nevi(moles), suture an excision site, and become more proficient at soap notes and stuff. I have been recommending treatment plans and medicatons, and writing the prescriptions. The hard part for me there is remembering the brand names. For the COMLEX, we had to know the generic names. But I invested in Epocrates Essentials for my handheld, and that is helping a lot. It offers a lot of features, including diagnoses, prescription drugs and doses, labs and values, etc. Take that along with an up-to-date pharmaceutical magazine and I can usually come up with the right drug and dosage.
We are also required to do a complete case study to turn in by the end of our fifth week, including history, physical, assessment, and plan. It should include osteopathic philosophy and treatment. Well, I was lucky enough to come up with a great case this week. I have begun writing it up, and after a second visit by the patient this week, I will probably have it ready to go. My preceptor is going to check it over for me before I turn it in. It is a difficult case with multiple problems, and the fun part for me is the opportunity to use my OMT skills to help relieve tension and pain, thus offering the patient some relief while we figure out all the other problems.
Next time we have minor surgery, I think my preceptor is going to let me do a little more of the surgery itself, and maybe inject the local anesthetic as well.
I’ll keep you all posted as the weeks go by. And, in about 4 weeks now, I’ll know if I passed my boards or not. Trying not to worry, but I still think about it from time to time. 
Linda, this is so exciting to read. And I hope you’ll pardon me for saying I’ll just snooze through the next four weeks because I already know you passed.
Four weeks down, four to go. It’s hard to believe I’m halfway through my first 8-week rotation. And it’s been a great continuation of my first week with many different diagnoses and many great experiences. The most interesting thing I can think of is seeing all of these different patients, many with same primary diagnoses (such as HTN, CAD or NIDDM). Yet, even though they may be the same in that way, there are a multitude of problems that make each one a learning experience in itself. And I have to say I have never seen so many dermatology problems as I have the last two or three weeks. It seems everyone either has contact dermatitis(such as poison ivy or oak), urticaria, Herpes zoster (shingles), tinea versicolor, or some strange unknown problem that we are still trying to figure out. And what about the person with 3+ edema in both lower legs, no thromboses in any vein clear up to the iliac vein, no history of hypertension or renal failure; yet they still have the edema and positive D-dimers. Then next week, on Monday we have two patients just diagnosed with MS, a newly diagnosed SLE on Wednesday, and many, many others with chronic health problems trying to learn how to cope with them. This is where I can really empathize and help them to understand that they are not alone; they must not give up hope; and introduce them to the support groups which are available to them.
I turned in my case study. It was a woman with dyspareunia and cephalgia(possibly atypical migraines). After several lab tests, including a pregnancy test and PAP (which I did), an ultrasound, and some OMT to help her cephalgia, we made the diagnosis of suspected endometriosis and tension headaches. I was able to help the headaches with some great OMT, and we referred her to a gynecologist for further investigation of the dyspareunia and suspected endometriosis. Anyway, I ended up with a 90 on my SOAP note for the case. I would have liked at least a 91, as that would have made it eligible for the case study award, but that usually goes to a fourth year student, so I guess I’ll just have to wait until next year.
Anyway, that’s about it for now. I think I’ll spend the weekend doing some of our required reading. We have a post-rotation exam and I would really like to do well!
Linda,
It sounds like you’re having a great time! I’m envious. Thanks so much for taking the time to let us all know what’s going on in your clinical life–it’s inspiring to those of us still in the pre-medical school phase.
Larry
Larry,
Thank you for letting me know you’re enjoying and reading it. The purpose of writing it is to let everyone know that while the road through medical school and rotations is difficult, it can be a lot of fun. AND. . . if this 54 year old can make it happen, then so can the rest of you!
Week 5 has come and gone so quickly. It seems the more I enjoy it, the quicker it goes by.
Hospital report this week has been very educational. And, for one of the patients I have been working with, it may even prove to have been beneficial. We spent Monday morning during report discussing liver disease and the different lab results you might see. Well, when I got to my preceptor’s office, I asked him if the new lab reports had come in on one of the patients, and it had. When we looked at these tests, we found she had elevated liver enzymes, elevated protime, and several abnormal coagulation factors. Add this to the still increasing D-dimer, peripheral edema, and leg pain(all in the absence of DVT or PE), and I told him I thought it might be a liver problem. So, I got to do my first referral to the doctor that had done the instruction during morning report. BUT, it seems this doctor is usually all but impossible to get an appointment with in less than a month. So, when I called, I told the appointment personnel that I was a medical student, had been conferring with Dr. ? about this patient, and could I please speak with him. To my preceptor’s surprise (and I must admit, maybe to my own as well), they got the doctor to speak with me between patients, and he said to get her to his office one day this week. Then, this morning at morning report, he told me she had been there yesterday, and after reviewing all the studies we had done, he feels she may have a vitamin K deficiency. So, he is doing some more studies, and at the same time beginning to treat the deficiency. It seems Vitamin K deficiency in adults is pretty rare, and that deficiency is often seen with elevated liver enzymes and abnormal clotting factors. I can’t wait for Monday to tell my preceptor that we finally may be seeing a light at the end of the diagnostic tunnel we’ve been in while trying to figure out her case!
Yep! I think I’m enjoying my rotations more every day!
Week 6 was a good week. More of the same general medicine, and more experience at psychiatric medicine with a great number of bipolar patients last week.
This week (week 7) has been an easy week for me. My preceptor is on vacation, so I have been concentrating on preparing to administer life support to my failed COMLEX. I spoke with the COMLEX advisor and the clinical psychologist. Both think I will be okay. Went to the dentist and got my teeth cleaned. Boy! That always makes me smile 
Saw my ophthalmologist and found out that part of my trouble with eye pain during the COMLEX exam was due to an ever-more mature cataract in one eye, causing it to have blurry vision and making the other eye more prone to stress. (Who said 16 hours of written exams was stressful?). Can’t do anything about it right now, though. My doctor said because I am diabetic and on prednisone for the SLE and pulmonary fibrosis, I might have more trouble with the healing process, and that would infringe on the study and time frame for the October COMLEX. So I’ll wait until later to get that taken care of. But he gave me some eye drops and advice on resting my eyes during the exam next time, so I think I’ll be able to handle it.
Had a great visit with our own Dr. Belle (see OPM family room), got a great osteopathic manipulative treatment from my favorite OMM specialist, AND got my hair cut, highlighted, and styled. My overall mood has improved exponentially! 
Of course, I have also attended all the hospital rounds. I really enjoy those. Learn a lot from them most days.
Next week is my last week of Family Med I rotation. I’ll let you know how it goes . . . and then I start psychiatry! I’m really CRAZY about that one!
Wow! My Family Medicine I rotation just came to an end! And I wish it could just go on and on and on . . . in other words, I really loved it!
My preceptor gave me a great assessment. I had no idea what to expect, so I am really pleased. But, most of all, I had an extraordinary experience and increased my knowledge and skills exponentially.
Next week it is on to psychiatry, which will enable me to improve my grasp on mental disorder pharmacology. There are soooo many drugs for mental problems.
I can’t believe I have just finished the first 8-week rotation of my third year! Bring 'em on. I just want more!
Congratulations, Linda! It is so thrilling to hear the excitement in your voice. Hopefully, your psych rotation will be just as rewarding. You have had some recent disappointments, but the satisfaction you get from patient interaction somehow puts it all in perspective, doesn’t it!
My thoughts are with you as you continue your journey . . .
Lu
Wow! That’s all I can say. Wow! I went into this psychiatry rotation thinking I just wanted to get done. That was all that mattered.
But . . . after the first week, I can honestly say, I am truly enjoying it! The doctor I work with is fantastic, and the PA I work with when he’s not in the office is just super!
I started off by calling his office last Friday to find out what time I should be in on Monday, etc. He told me 6:30 a.m. and be sure that when I get there I shine his shoes and make him some coffee. Somehow (I can’t imagine how) I knew he was pulling my leg. So, I told him I would, but I am required to do morning report at the hospital at 7 a.m… So, if it was okay with him, I’d be there about 8:15, and I’d gladly shine his shoes then and, of course, I’d bring him a nice hot cup of hospital java!
Monday morning found me following around a 4th year student as she interviewed and presented patients. By Monday afternoon, I was interviewing and presenting the patients myself. Doc has a pretty simple format to follow, so it isn’t difficult. But I learned a lot! Anyway, I would interview the patient, and then go with them to Doc’s office and present the case (with the patient there). I would then tell him what my assessment and plan were. If I felt they needed medication changes, I would include those, and if he agreed, I would simply write the prescriptions and he would sign them. If he thought another plan would be more appropriate, he would explain it to the patient and to me in a way that was informative. He NEVER, NEVER makes me feel stupid!!
The entire week I have spent working with either him or the PA. She is super, too! Both of them have told me I am doing an excellent job with my presentations and decisions. I have seen every type of patient imaginable. From little kids to really old folks. From sexual, physical, and/or substance abuse to simple anxiety or depression. Add to those ADHD, obsessive/compulsive, panic disorders, generalized anxiety disorder, and lots of others, and that’s what I’ve been doing.
The amazing thing to me is that I am actually enjoying it. I know it is not a field that I would want to specialize in, but I also realize that as a family physician, I will be seeing a lot of these patients on a regular basis. The knowledge and experience I am gaining will help me immensely!
Anyway, that concludes week one! Three more to go. I’ll keep you updated!
So another week has gone by with still more exciting experiences. There have been several emergency interviews with patients that were really close to going over the edge and either running away or committing suicide. It is extremely challenging to work with some of these folks as they have problems I will never be able to totally understand because I have never been in their shoes. BUT, the one thing I have found in common for almost everyone of the patients I’ve seen in the last two weeks is that they need someone to listen. I mean REALLY LISTEN . And that’s one thing I am really pretty good at.
Besides working with the patients, my preceptor has given me a lot of other work to do. Like dictating letters to the patient’s PCP or to insurance companies and even one that will go to the child protective services. Of course, he will review them before they are official, but he has told me that he has complete confidence in my abilities.
So next week will begin with a luncheon provided by one of the pharmaceutical reps. My preceptor told me to take the morning off and sleep in. Somehow when I told our DME that I was to sleep in and skip morning report, he wasn’t very happy. So I’ll probably go to report and then go home and take a nap.
Went to the white coat ceremony today for the incoming first-year students. I always enjoy going and listening to the keynote speaker because it reminds me of why I am here. It means a lot to me. I know. That may sound silly, but I’m a pretty emotional person. I also went because I knew three of the incoming students and I wanted to be there to support them and meet their families.
Oh, by the way, for those of you who live far, far away from West Virginia, don’t let that stop you from applying here. This year’s incoming class has 60% out-of-state students, and a lot of them are from far away places (like California, Idaho, and even Oregon! Are those really part of this country? ) AND with next year’s new class increasing in size from 104 to 180, there should be lots of opportunity for admission!! Add to that the fact they are really nontrad friendly and . . . GO OLDPREMEDS!!
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Oh, by the way, for those of you who live far, far away from West Virginia, don’t let that stop you from applying here. This year’s incoming class has 60% out-of-state students, and a lot of them are from far away places (like California, Idaho, and even Oregon! Are those really part of this country? ) AND with next year’s new class increasing in size from 104 to 180, there should be lots of opportunity for admission!! Add to that the fact they are really nontrad friendly and . . . GO OLDPREMEDS!!
Hummmmm … funny how some things come back to “bite” you … my entire family is from WV. But, over the past 30-some years, all but four have migrated to FL. I’ve been here since I was about 3 and have spent most of my life hiding my WV roots. About 95% of The Family has embraced FL with the other 5% still swooning about WV. So, when I started considering which schools I might apply, your discussions on WVSOM perked my attention. I will have to stop scouring when the 5% are romanticizing about WV. I don’t necessarily have any poor memories of the state — just hate the hillbilly comments
… Guess this year I’ll be sitting in the living room rooting for WVU with the rest of 'em.
Linda,
I’m just about to finish Psych II (my school does two 4 week rotations), and I have found “First Aid for the Psychiatry Clerkship” to have some good hints on the drugs, and is a good review book. I’ve also found “High Yield Behavioral Science” to have a really nice combination of High Yield information (drugs and other stuff), but pretty good depth, too. At least, I hope it’s been the right amount of depth-- the Shelf exam on Friday will tell me, I guess. It has been a really interesting rotation. I found neuropsych and cognitive testing fascinating. People are incredibly proficient in overcoming and hiding some pretty significant deficits.
Deb
Thanks, Deb, for the book suggestions. I think I’ll probably pick them up before I do the second psych rotation. And, Funkill, WVSOM is a great school with an administration that smiles on nontraditional students.
Now the bad news. Week 3 of my psych rotation has come to an end. And, yesterday afternoon, my preceptor told me and his PA that he was going to fail me 
. . . . because that way he could have me there for another 4 weeks!! He told me I have been the best medical student and given the best presentations of any medical student he has had. Boy, was that good for my COMLEX-battered ego!
I have to say that this week was even better than the first two. I went with my preceptor to a facility for troubled teens. There were lots of young teenagers there with a multitude of problems; from drug abuse to crime to family abandonment, etc. We had 6 or 7 kids scheduled, 4 for initial interviews and assessment and 2 or 3 for medication checks. I was allowed to do the initial interviews on two of the kids. They were extremely difficult, and let me tell you, teenagers can be really hard to get to talk. But, by the end of one of the interviews, I had one young lady who had given me information concerning sexual abuse by her mother’s boyfriend that her counselors had not been able to get her to talk about. They knew it had happened, but she had refused to talk about it at all because the guy had threatened to kill members of her family if she told anyone. I have never seen a young teenager with such huge tears, but after we had discussed it, you could literally see the weight lifted from her shoulders as she skipped down the hall and stairs.
Anyway, I only have 4 more days next week of this rotation. And, like I told my preceptor, it has helped me to understand mental health issues tremendously. And, I can honestly see how understanding these things can be of great benefit in my future family practice.
After I finish my last week, it will be on to my OMM Osteopathic Manipulative Medicine) rotation. This one I can hardly wait for!
More later!
Well, it’s over. The rotation I had dreaded came to an end. The sad thing is, I was enjoying it so much I really didn’t want it to end yet! These four weeks in psychiatry have given me a much deeper appreciation for the field and some great insight into myself.
Besides having the opportunity to learn a lot about the various types of mental illness and medications and treatment plans appropriate to each, I came away with an awareness that proper medical treatment can be of tremendous benefit when administered with compassion and understanding of the underlying issues affecting each patient.
While it seems to me that the medical profession didn’t know a whole lot about treating mental disease a few years ago, I think tremendous strides have been made in recent years.
And to top it all off, my preceptor graded me as ‘truly exceptional’ in two of the four graded categories and as ‘excellent’ in the remaining two. Grades like that, of course, always feel good and are very encouraging for future endeavors.
Now, it’s on to osteopathic manipulative medicine, which as you all know, is one of my favorite areas of treatment. Can’t wait for Monday!