Cherry Picking Skills

by chelseajin

I’m watching everyone really carefully and picking out things I like. Betty is super analytical, and if she’s not sure about something, she’ll just go ahead and do all the background labs to check. In this world, better safe than sorry, but she strikes a good balance where she’s not overly conservative.  Edgar is oddly really collected, and so polite. When we were down a person, no one else really formally announced it, but he came in and just clasped his hands to tell the doctor, you know, we’re really sorry but bear with us because we just lost so-and-so. That totally changed the atmosphere from crackly-annoyed to on-alert and how can I help.

Maria, the MA student now volunteer, is keyed into something I have the most trouble getting down. She has this silver tongue that just chats people up and makes the donations flow. Our cash jar was so dry when I was around, and I admit I could have been more proactive about that. But I had conflicting interests, you can be at the front office and with a patient at the same time. But I just watch Maria and she really steps it up by using her own initiative to make payment plans and find companies willing to donate money or supplies. It easy to talk about this stuff but someone actually needs to do the legwork, and she loves doing it.

I’ve been able to work with and shadow several of the Family Medicine residents and there are a few I really like. Paul got to come on the van just the week before and I’ve always been struck by how level-headed he is.

I think because I’ve been in a small school for so long, just fighting other people to secure a spot, I’ve forgotten to think about just me instead of me relative to others. He stands up straight and tall and when he puts on his white coat, I get the distinct feeling of his pride. He’s a sharp guy and remembers details of the papers he reads, and is nice about bringing them up as conversation points during the residents’ teaching day. I had no idea he was bilingual, and he just goes smoothly to seeing his patient on the Mobile and seamlessly starts speaking Spanish, at a slow pace, clearly, and it’s nothing too high-tech. In fact, I could do it easily myself but I always find myself giving myself a prep talk before I go into an exam room. Why the hell am I so nervous? The patient feels at ease because they feel confident they can convey what they need to and it goes so much smoother than when a nervous wreck of a resident starts off with “hi, I’m doctor ____ and I’m sorry but my Spanish is not so good”.

So I’ve been channeling some Swenson. I just tell myself to be confident (not overconfident) and just take it as it comes. Spanish isn’t hard, it’s just there and I can reach into it whenever I want.

He was also able to reset the Babbling Brook’s attention by touching his knee, and has this great sense of empathy. Smoking cessation talks are canned. Both patient and doctor know what the script is and both know that unless the patient is in a life-threatening situation or really emotional, nothing’s going to happen. The way Paul was looking at this young guy, asking him, “Don’t you know what happens when you smoke? You should really think about quitting. What’s stopping you?” I realize now, the approach was different because he was using a bit of Cognitive Behavioral Therapy, he wasn’t just lecturing, he was really trying to give some psychological counseling. And you could tell the guy was a little spooked and was starting to actually get introspective.

As a person, he’s a great conversationalist. He’s actually the first resident I spoke to and had closer contact with. It was funny…he invited me to a potluck with the other members of his year, and I thought I’d be there at a good time by arriving an hour in. No, all the residents have children and are working so they came early and left early. He had the grace to let me stay for an hour and entertain me before turning in to bed.

So you can tell he is a great teacher. But now it’s firmly stamped in my head, you can’t ever hope to be a good teacher if you don’t know it all. He has a mastery over physiology and explains to patients a disease process so that they’re not just following doctor’s orders, but are able to take control of their own health. I guess on a certain level, health care providers are afraid of it because it means less authority for them, less of a blind following of directions and challenge, “are you sure this is the right medication for me?”

Med students complain (and that’s a recurring theme, med students complain, a lot), that they have to go through so much theory that just isn’t useful clinically. It can be. If you have a good understanding of something, even Biochem, it makes you that much more powerful and effective as a provider. If you can’t explain why something is wrong with someone, how can you expect these people to trust you with their health? He really inspires me to remember mechanisms behind things and not act like other people, tossing the process away and just thinking of the end results.

So how did I use this.

I remember this woman as a super black-haired lady. It was obvious she had dyed it, it had such a luster and intense black almost blue tone to it. Small Hispanic woman, hair in a thick braid down to the small of her back. I go in with her and introduce myself real casually, I’m Chelsea, a medical student, I want to ask you a few questions before I had the nurse come in and see you. And she’s pretty impressed, some of her anxiety is loosened as her face relaxes.

“Oh, you speak Spanish?” and I tell her yes, I learned in high school, and it’s just going along swimmingly. She tells me she’s worried she has something wrong with her heart because of a pain in her arm. Ok, so it’s muscular or maybe she does have some kind of blockage and stress on the myocardium. I try to have her characterize the pain, and it’s not radiating anywhere, kind of dull, more in the arm than anywhere else. I have her do some movements to test the rotator cuff, and palpate her back. She has no contributory history and is in overall good health. She actually seems more on top of her diet than I am! So I think I’m feeling very tight muscles and just strain. I tell her this and have Betty come in and verify since anyone having heart issues is automatically a big deal. She agrees and I think we decide to give her some ibuprofen and flexeril at night.

A “boring” encounter, sure, but it ranked as one of my best. I was so in control of the situation, I knew what I was looking for, and the patient was at ease and willing to tell me more about her condition. What I’ve noticed happening with the Spanish-speaking patients is that they clam up when they realize the provider can’t speak Spanish to them. But I went calmly, slowly, not trying to prove my fluency and it was awesome.

Speaking of smoking cessation, afterwards we had a woman who wanted to refill her bipolar medication before going on a long trip. You would think that was the big deal, but it was her lungs. I haven’t had anyone with appreciable sounds until her, and there was wheezing. I asked if she had asthma. Yes. Smoking? Yes. Quitting? Ehh… not really, will think about it? I probably would have pushed more if she wasn’t so obviously closed to the idea of quitting. How do you get someone to the point of just starting to think about quitting? Hm… guess I’m googling that and some psych material.