solo

Today in free clinic was my first day seeing patients solo.  It was something of a fluke - a lot of clinical students canceled, but as we had an excess of preclinical students (as we work in teams of a first or second year student with a third or fourth year student ), our clinic coordinator decided to have one of the first year students see patients solo, report to a third year student, then see the attending.

The first year looked a little discomfited, so when I heard this, I immediately volunteered.  He looked relieved; I ended up being both excited and nervous.  In some sense I had a lot more responsibility for patient care because I was now completely responsible for the encounter, needed to figure out the right questions to ask and ferret out the symptoms alone.  Also, I've spent enough time entering lab results and doing referrals that I knew the system, so I persuaded them to let me enter notes for the clinical student (as it would have taken more than twice as long if she actually had to write them).  I was pleasantly surprised to have a pretty decent idea of how to use the computer system just from watching others enter notes.  I was also glad that my time in the hospital seemed to come back to me so I knew how to interview solo and knew how to write a decent note.

I ended up seeing just two patients - one with a ganglion cyst, one for STD testing.  I had just read a JAMA essay about a doctor who treated a the fluid-filled cyst by the classic treatment of "banging it with a Bible" and was thrilled that I did recognize what it was.  (No, I did not smack the cyst with a large book - we referred him for surgical removal.)

In any case, my confidence did increase a lot.  The clinic coordinator felt that my notes were adequate, and my presentation to the attending seemed reasonable.  But I really need to review diseases and management because many of thing things that went by my first two years are suddenly relevant and important.