Non Traditional Love

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Nov 14, 2008
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I sure know how to grab an audience with a title. Anyway...

So, I'm nearing the end of my weeklong medical student observership in anesthesia (even though im not a med student, a good case not to follow the odds all you odds counters!!!) :D . i wanted to pass along some fun notes that this non-trad was able to pick up along the way.

silly stuff, day one, getting badges, all the 24 y/o 4th year students wait in line in front of me, all get addressed as ma'am, ms, mrs., son. i get the royal, "Doctor and Sir treatment." hilarious. this makes premed years a bit more tolerable.

was tossed around lovingly by all the pain department docs including: anesthesiologists, physiatrists, neurologists, neurosurgeons, interventional pain, i saw it all. i think it was a good sign that i was tossed around actually. you could argue that people wanted to get rid of me, but it was quite the opposite. a bunch of MDs wanted to introduce me to the Chair, which they did. claimed they "stole me" from other docs and so forth.

my main MD who approved this kept saying, "this is your rotation, do whatever you like." and i did. if i was waiting around for a patient to arrive to pain, i would mosey up to neurologist reading films and introduce myself. can't really hurt.

a few lessons learn: if you are observing/shadowing, there is a certain etiquette. i used 35 years of common sense. pass a bit along. #1) respect is key. calling a doctor "Dr. X", you can't really go wrong. I wouldn't DARE call my MD by his first name. So, remember the chain of command. #2) When seeing patients, i sort of used a rule of thumb: when doctor stands, I stand, when he sits I sit. This way, I was never standing when he was sitting, thus usurping his stature (im tall, but this rule applies) and also, i was never sitting, and feeling lazy while he stood to do an exam. Only once did I lean on an exam table because the pt brought the troops in to the room and I was shoved there. it seems strange, but i didn't want to look down at my MD while he was talking to pt. for me, thats easy. im tall. #3) i mentioned leaning, i don't do it. don't lean on chairs, counters, walls, exam tables, it's really unprofessional. ever see your DR do it? i don't. by the end of the day i was nice and achey. oh yeah. #4) make friends, make contacts, network. be a nice NUDGE. but don't over do it. I cant explain this. you either get it or you dont. #5) everybody is somebody. my MDs secretaries were dolls, from the moment i walked in. and tomorrow, ill thank them as i would thank my MD. for purposes of life: don't look down on anyone. for self serving purposes: you never know who might say, "hey, Doc 712 is so sweet, you know anybody who can help him..." it's not all about that, but remember everyone. #6) that goes for nurses, PAs, scrub techs, environmental. the moment you break this rule, it will bite you in the ass. luckily, i worked in a VERY COOL department. #7) a bit more on this: leave your ego at the door. at this internationally renowned hospital, my MD asked a YOUNGER DO for his advice reading a film. why? because a doctor is a doctor at this hospital. and i love that mentality. #8) always have your sh$t together: pens in your pockets, i had to give mine away to forgetful docs, don't get caught w/o money or a pen or anything really. be prepared. #9) don't be late. even if your MD is late. always. like mine. ;) #10) have FUN! this is what it's all about. ask questions. know limits. know when it's time to walk out and give the MD his time to talk to his wife. be curious. that's what medicine is all about. enjoy the experience. today, when i was bored, i walked over to films, and asked the DO "these films of your patient." he said, "yes." then paused. I'd been there all week. He goes, "What do you see on them....?" OH NO, i thought. did he JUST ask me that. and is that dr. x looking my way now? and dr. y, the neurosurgeon eyeing me too? so, now or never. i'd been reading Lumbar spines all week. 40 hours worth. here we go. "Well, Dr. G. I see three main problems that might be causing pain. First, I see foraminal narrowing on L5." He concurs. There might be some. "And, I also see some spinal stenosis in the (can't see if that's L5 or S1, now I know, but too late...) sacral area." Uh oh, Dr. Y chimes in, "Yes, but the sacral area in fused, so no spinal space really, you mean just above S1, right?" YEs, I do. "Yes, I do. I also see triangulation on these Axial images. But I'm not sure what to make of those." Dr. X crosses over and says, "That's right. And that's where I see the pain coming from. Her pattern doesn't show L5 pain, it's coming from here, where the Ligament shows hypertrophy into the space." Me: "The Ligamentum Flavum." Him: Yes. :D So, I have officially been pimped, and I'm not even done with O-Chem! Rock on. Anyway. Lastly, don't be afraid to say you don't know. That's key. Because at our level, we don't. And also, um, it never hurts to do some homework and reading in the area you are in. Lastly, #11: be a good listener. I see docs do this well, and others, not so much. But for me, sometimes my Doc would start talking and I was already thinking about another question, rather than hear what was going on now. I made a point to focus on what was being said. If only because I wanted to make sure I had it down in case I was asked.

As a 6'4' non trad, with some salt n peppa, all the docs introduced me to their patients differently, "A student observing." "Dr. 7". "A Visiting Professor." (Thats my fave, until the pts would ask ME questions). Anyway, Docs can have fun and be down wit it too.

One doc, not my main MD, let me listen to a carotid artery during a back pain visit. FIRST time anyone has let me do that. "Can Dr. X listen to your arteries?" Such a nice MD. I listend and said, "I heard a woosh." After the visit, the MD told me thats actually a Carotid "Bruis" and it can be VERY dangerous.

At another moment, reading films, my MD asked me, "So, which foramen is narrow?" Before I could move my finger down to it, comparing, he had the mouse curser there. BLAST! Speed comes with time. I just needed another 10 seconds. too slow though.

I've had an AMAZING experience, and can really see what Comprehensive Pain Management (Neuro/Anesthesia/PM&R/Surgery) is like. I see many different ways 2 docs will approach the same old problem. I see how Doctors (specialists) really do just that and become machines in their own areas. I mean, after only 1 week, I can read spinal MRIs, Xrays without any significant problem. I'm no pro, but I'm really decent at spotting certain problems. And the spine is really complex, i mean, it's the SPINE. Why can I do it SO much better Thursday than Monday? It's all I saw all week long. Didn't see one Knee Xray. Not one hand Xray.

Enjoy your shadowing experiences! I am living it up in mine. In 7 hours, back to the OR to observe anesthesia from the perspective I love the most.
Then I've already planted the seed to spend a couple overnight shifts in ER with the Chief there. So, another note, before the door closes, figure another way to keep it open. :idea:

PM or write here with other thoughts and ideas to help fellow observers.

Night all.