Archive for Field of Family Medicine
09.12.09
Posted in Education/Curriculum, Field of Family Medicine, Social at 11:17 pm by mark song
From knee-high pink stockings and spandex to Michael Jackson’s famous white glove, the atmosphere was vibrant and ebullient at the massive downtown Kansas City Convention Center. Add to the mix The Spazmatics, an 80’s cover band, and what you’ve got is one serious tribute to all things 80’s. Welcome to the first day of the 2009 AAFP National Conference for Residents and Students! What could’ve been mistaken as an 80’s convention filled with fanatic Breakfast Club devotees was instead the orientation/registration day to our annual conference. As Los Angeles natives, we, of course, dressed the part, and donned white gloves and sunglasses of our own. The outfit was low-budget, extremely easy to put together, and very well received – a testament to our collective creative stretch unbound by our limited means.
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07.01.08
Posted in Education/Curriculum, Field of Family Medicine at 9:47 pm by Casey KirkHart
If you happen to get sick this summer in Southern California and you wind up at my hospital, you can expect to find a gaggle of eager, intelligent, competent and caring new, young doctors (we like to call them ‘interns’) ready to listen intently to your story, as well as your heart and lungs of course. They may be ‘green’ but they certainly aren’t dangerous so long as they’re armed with 2 important tools: supervision & sleep.
The former seems blatantly lacking the story quoted below.
Every neophyte is owed the opportunity to be taught so long as the teacher recognizes her imperative to teach. Especially in a hospital in July.
New Docs on the Block
According to medical lore, July is the worst time to be hospitalized because that’s when inexperienced med students start clinical training. But is summer really riskier for patients?
A month into Sandeep Jauhar’s medical internship at a prominent teaching hospital in New York City, he was asked to drain fluid from the belly of a patient who was HIV-positive. “I was trying to get out of the hospital to keep a dinner appointment,” he recalls. “I was sort of rushing. I heard a snap and there was all this fluid leaking all over the floor.” Jauher’s gloves were too small, he hadn’t assembled the tubes for the blood correctly, he was new, he was inexperienced and nobody was watching. “[The patient] was totally oblivious to the disaster, but it was a mess,” he says. “These are the mistakes that new, green interns can make.”
According to conventional wisdom, a patient’s chances of encountering a mistake-prone rookie like Jauhar go way up in the summer. That’s because July 1 is the start of the academic year for medical schools: In teaching hospitals around the country, medical students will replace interns, interns will replace residents and residents will move on to fellowships or to become full doctors.
This crucial and sometimes perilous training period can be incredibly difficult for medical students. As Jauhar writes in his recent book, “Intern, A Doctor’s Initiation,” incoming doctors are not only practicing on patients for the first time, they’re also learning the often Byzantine workings of their respective hospitals, new technical language, new procedures and the tedious, yet critical, ways to fill out paperwork. All this learning is packed into 80-hour workweeks and overnight shifts in a busy hospital environment—a far cry from the academic environment they might be coming from. But is it really riskier to go into a teaching hospital during those first few weeks of intern training? Or is the “July phenomenon” a medical myth?
Finish reading at New Docs on the Block
~casey
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08.01.07
Posted in Field of Family Medicine, Professionalism at 8:51 pm by los anjalis
Ah. We’re here! 5 residents from our program (Jose, Suganya, Casey, Eva, and myself) arrived in Kansas City, Missouri today for the annual American Academy of Family Practice (AAFP) National Conference of Family Medicine Residents and Medical Students. We’re accompanied by our wonderful program director, Dr. Castro, and our associate program director, Dr. Sanchez. Thinking back, this specific conference is what introduced me to this residency program in the first place. I’m from the east coast — New Jersey and NYC to be specific — and I had no way of knowing what programs fit my interests well. I remember feeling a little down (and exhausted) after walking by many many display booths at this conference when I was a 3rd year medical student. After a few long days of talking to many programs, I felt a connection to a few, a handful of them who I felt really walked the walk and did not just talk the talk in regards to broader public health issues, resident-driven change, and sustainable community outreach. And then — love at first sight. I glanced over at one table where a slideshow was being shared, and I saw photos of residents rallying with SEIU for healthcare reform; I saw photos of resident-driven international trips; I saw photos of residents running the show at a resident-founded homeless clinic. I talked to the residents and faculty at the table, and I heard more of the same, accompanied by a sense of satisfaction and a sense of humility. This was exciting! Long story short, the conference introduced me to my top choice program in the country, and I’m ready to play the role of excitedly sharing the program with medical students.
We set up our display booth this afternoon, which was quite fun, we’re pretty excited about it. We’ll have video from our residents and screenshots of this blog and our wiki (resident-driven collaborative learning/reflecting) on two laptops at our booth.
The freebies here are interesting. There are some really fun ones, like the program that brought the portable popcorn maker and another program that brought a smoothie machine. Some of us think it’s little disappointing to see so many pharmaceutical companies’ huge display booths — very expensive and schmancy ones at that — set up among the family med residency booths. We’re not quite sure what the purpose of them is…
More reporting back from the conference later…
-anjali
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07.27.07
Posted in Education/Curriculum, Field of Family Medicine at 10:51 pm by Casey KirkHart
Hi all. No, not another anti-Pharm diatribe from me. This one is a clinical diabetes case from the Harbor-UCLA family medicine clinic:
You all know that a few of us family med residents have been involved in the diabetes chronic care collaborative with Drs. Snyder and Cheng. We’ve been trying to provide intensive and attentive care (including testing, treatment, education, and self-management) to our most out-of-control (OOC) diabetic patients. As the Resident Clinic Director (aka “RCD”) for the last month (a required and worthwhile rotation as a 3rd year resident), I’ve been on the front line of patient care at the Family Health Center. Here’s an example from today’s RCD experience that shows what we’re up to.
* Please email me if you’re interested in participating in the chronic care collaborative!*
One of our nurses, Mahdi, alerted me to a patient with fasting blood sugar 256. (This is something you have to address in the few spare minutes you have while RCD between triaging urgent care patient, writing for med refills, and putting out the occasional fire (ie someone with chest pain, residents swamped with clinic, etc) that erupts in the waiting room. It’s fun, actually.) This 66 year old Latina lady with her daughter at her side explained that she’s NEVER been in control of her diabetes in the 15 years she’s had it. Her last Hemoglobin A1c in 1/07 was 9.8% (far above her goal of 7%). Her home sugars run 200 to 400. She’s been seen only a couple of times here, but already her meds are maxed out: metformin 2500mg a day (about max dose), pioglitazone [Actos] 30, glipizide 20 bid (max). So, fair doctor, what do you do?!
Obviously her oral meds aren’t doing it. Your choices are: increase the Actos to 45 a day (max dose)? Start a 4th agent – acarbose, Januvia? All of the above? Start insulin? Take a second: based on what you know about this lady’s diabetic control, how can you best help her?
Well, a little bit more of the story helps. First, she and her daughter are asking for insulin. That doesn’t happen too often (many of our patients fear that insulin causes blindness, amputation, etc – Educate patients, people!), but when someone has a chronic, debilitating condition that isn’t helped with maxed oral meds, she knows that only insulin can help her. Smart lady. Fortunately she’s been given insulin in the past so knows the routine. I start her on NPH 10 units (she’s thin, so 10 is a good start. If she’s obese, I might start 16 units) before bed and counsel her on increasing the dose every 3 days by 2 units if her AM fasting sugars are >130. Both she and her daughter understand, but adjusting insulin like this is tough for newbies; she might need more counseling in the future…
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