First Clinic Patient

[ddown]

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Alright everyone, I had my first clinical patient yesterday and what a doozy it was. 29 YO Hispanic female, VERY limited english, undiagnosed bilateral refractive amblyope (OD -12.00-2.50 X 175 OS -3.25-0.50 X 002) with chorioretinal scars of either toxoplasmosis or myopic degeneration etiology. Ended up getting her to 20/50 OD 20/30 OS after a lot of dial spinning. Talk about feeling like you are way over your head.

Anyone else have any good first patient stories?

 

[rpie]

Alright everyone, I had my first clinical patient yesterday and what a doozy it was. 29 YO Hispanic female, VERY limited english, undiagnosed bilateral refractive amblyope (OD -12.00-2.50 X 175 OS -3.25-0.50 X 002) with chorioretinal scars of either toxoplasmosis or myopic degeneration etiology. Ended up getting her to 20/50 OD 20/30 OS after a lot of dial spinning. Talk about feeling like you are way over your head.

Anyone else have any good first patient stories?

Sounds like you got a good work out 😉

I don’t remember my first patient, but thought you all may find this case interesting. It challenged my patient management skills.

A 14 Y.O. FM patient came in to see us because of a “ red eye” She was fit with SCLs from a local Doc. in the box, and had a stringy mucous discharge for the past 2 days. Her parents are on vacation for next 10 days so she needs to get her eyes cleared up before they come home. SLE shows the usual papilla/ follicles, SPK associated with a bacterial keratoconjunctivitas. I usually do not do and eye Culture on everyone but for this person, I decided to do so before initiating treatment with Zymar. Lab results come back positive for Chlamydia so I change her over to Zithromax, and also had her see her PCP. Everything clears in about 3 weeks.

She comes form a middle class family that thinks she can do no wrong. Since her parents are concerned about her welfare, they ask what she had, why the initial medication was changed, why she had her see her PCP , and why it took about 3 weeks to have everything cleared up.

The parents are not aware that their daughter is sexually active, but her PCP is aware because she Rxed her BCPs, but evidently did not inform the parents.

How would you answer the parents?

 

[Tasteestuff]

Sounds like you got a good work out 😉

I don’t remember my first patient, but thought you all may find this case interesting. It challenged my patient management skills.

A 14 Y.O. FM patient came in to see us because of a “ red eye” She was fit with SCLs from a local Doc. in the box, and had a stringy mucous discharge for the past 2 days. Her parents are on vacation for next 10 days so she needs to get her eyes cleared up before they come home. SLE shows the usual papilla/ follicles, SPK associated with a bacterial keratoconjunctivitas. I usually do not do and eye Culture on everyone but for this person, I decided to do so before initiating treatment with Zymar. Lab results come back positive for Chlamydia so I change her over to Zithromax, and also had her see her PCP. Everything clears in about 3 weeks.

She comes form a middle class family that thinks she can do no wrong. Since her parents are concerned about her welfare, they ask what she had, why the initial medication was changed, why she had her see her PCP , and why it took about 3 weeks to have everything cleared up.

The parents are not aware that their daughter is sexually active, but her PCP is aware because she Rxed her BCPs, but evidently did not inform the parents.

How would you answer the parents?

Yikes 😱

PCP WILL be in some serious trouble. giving 14 y.o girl BCP w/o parental permission... 👎

 

[Ben Chudner]

Yikes 😱

PCP WILL be in some serious trouble. giving 14 y.o girl BCP w/o parental permission... 👎

Depends on the state. In Washington State, the legal age of consent for medical is 14.

 

[rpames]

My first clinic spot is tomorrow. 😱 I've been reading every book and lecture I have that I think could help me. I'M FREAKING OUT. The attending could ask me anything! What if I don't know the answer to a very easy question? I'm off to read about binocular testing.

 

[JG777]

How would you answer the parents? I think this is a very good question to ask b/c it brings up ethical matters. Do you respect the patients' request to not let her parents know about her sexual hx? Or, because she is a minor, should her parents know about the Dx, which is a direct result of sexual activity?

If the parents ask, don't you have to tell them since the patient is a minor?

 

[cpw]

My first clinic spot is tomorrow. 😱 I've been reading every book and lecture I have that I think could help me. I'M FREAKING OUT. The attending could ask me anything! What if I don't know the answer to a very easy question? I'm off to read about binocular testing.

deep breaths rpames.. deep breaths. Attendings know you're freaked out to see your first patient. Fortunately, mine was a good friend of mine. (a presbyope, but a good friend) I look back now and can't believe i used to freak about seeing a presbyope

Make sure to post and let us know how it goes !!! 😀

 

[rpie]

How would you answer the parents? I think this is a very good question to ask b/c it brings up ethical matters. Do you respect the patients' request to not let her parents know about her sexual hx? Or, because she is a minor, should her parents know about the Dx, which is a direct result of sexual activity?

If the parents ask, don't you have to tell them since the patient is a minor?

Like Ben indicated, it depends on the State. Since the patient is considered a minor in the state that I practice, I would need to inform the parents. 😱

I was very fortunate that the patient’s PCP was an old friend and classmate who was also the patient’s auntie. Since this was a family matter, “auntie PCP” took care of the questions