Personal Reflection:
On this day in particular, we saw a large variety of individuals in outpatient with Dr. Clement. Male, female, young, and old, presented with different complaints that reminded us of the glimpse into pathology and medicine we had in our first year of training and how much we must learn in our next. More importantly, as our time passed at Bethany, the amazement of knowledge became overshadowed by the sincere and mutually beneficial relationship between these physicians and their patients. No matter the severity, patients showed gratitude and appreciation to the medical staff; no matter how "trivial," the medical staff provided equal time and attention to all patients. Observing these connections gave me insight into this rural and non-Western medicine, an experience I lacked beforehand. It also increased optimism of my future career, despite associated negatives often given in discourse.
Clinical Perspective:
This day provided some pearls in medicine. I'll list a few brief patient cases and interesting insight given by Dr. Clement in order to properly assess/treat/maintain patient health.
Patient 1: This young woman presented with L foot pain after blunt force trauma, however had no fracture on her X-Ray. A ruptured ligament is severe enough to treat as a fracture (complete immobilization for 3-6weeks), however will likely appear as a negative x-Ray. If there is suspicion for ligament damage, a "stress X-Ray" could be performed. Take a normal X Ray of foot and compare to manipulated X ray of foot. For example: if suspicion for lateral ligament tear, turn the foot inwards (intorsion), get image, and assess for increased spaces between tarsal bones.
Patient 2: 74 y/o female with abdominal pain and previous history of recurrent cholecystitis and gall stones recommended for cholecystectomy. Although the patient was older, she also agreed that surgery would be the most beneficial.
Patient 3: Middle aged man with PSHx of R inguinal repair presents with L deep inguinal hernia. In our M1 year, we learned this is medial to epigastric vessels and courses through both the deep and superficial inguinal rings. For men, this can enter the scrotum.
Dr. Clement informed us that hernias are reducible and can reappear after a "cough impulse". Indirect hernias typically course through the deep ring and enter the abdominal wall.
Patient 4: Older woman with an auto skin graft (taken from anterior upper thigh) to L dorsal foot. On examination it was healing well and the dressing was to be changed. We were told that applying ionized silver compound can promote healing and is applied before a new dressing is placed.
Patient 5: This man appeared in excruciating pain and we learned he had abdominal complaints. He was grunting and writhing on bed and admitted for alcoholic gastritis. Follow up in other blog posts.
Patient 6: Older woman comes in for a check up. She has a diagnosis of a carcinoma to the lateral aspect of the posterior 1/3 of the tongue. She refuses any chemotherapy or radiation treatment, but presented with neck lymphadenitis on the same side as the tumorous growth. She does accept antibiotics and analgesics for relief. Dr. Clement told us that it is important to allow patients to have control of their own treatment and health, while being supportive and wanting the best for them.
Patient 7: a pre teen boy presents with his mother who reports some puffiness of his face. He has a history of acute glomerulonephritis with secondary hypertension and was treated accordingly. These new findings are concerning for other residual problems. On examination, the child had a systolic and diastolic murmur which was suspicious for rheumatic carditis secondary to his previous condition. This change is often associated with streptococcal infections.
Patient 8: a middle aged healthy appearing woman came in for a wound check up. She had a biopsy of a tumor of the R medial upper thigh. Results showed a hemangioma, abnormal growth of blood vessels which can possibly spread to the bone; however, most patients are typically okay! She had a positive prognosis and was content.
Patient 9: This woman complained of pain to multiple joints and was diagnosed with polyarthralgia in clinic. Further assessment is Needed before a polyarthritis diagnosis. Dr. Clement ordered an ESR, uric acid, serum creatinine, and rheumatoid factor as tests.
Patient 10: A mid aged woman complains of chest pain and her EKG showed T wave inversions in all anterior leads. T wave inversions are significant for cardiac damage usually secondary to a previous infarction in that area. Interestingly, on her repeat EKG, these inversions were not noted but other changes were seen. She was given a diagnosis of unstable angina and admitted for further evaluation.
Overall, this day was super informative and I enjoyed the mid paced nature of seeing a variety of patients in one setting, but being able to give them adequate time for their needs to be met.
P.S. There was a spicy coconut-curry-cabbage medley that was so delicious. We all ate that day with such ferocity. A picture is below!
-Simi
No comments:
Post a Comment