What’s In My White Coat: Surgery Edition

From top left:

1. ID and scrub card: It’s always a good idea to have a pair of clean scrubs available.

2. Scalpel: For emergency airways. (Seriously, you should always have one with you. At the very least, you can hand it to someone who knows what to do.)

3. Dr. Pestana’s Surgery: This should actually be in your scrubs so that you can read it during downtime (in pre-op, for example).

4. Stethoscope: You need to evaluate bowel sounds for post-op checks.

5. Xeroform gauze

6. Lube: Because every GI bleed and acute abdomen requires a DRE. (You've heard this joke, right? Q: When is it okay for the medical student to skip the DRE? A: When they don't have any fingers.)

7. Scissors

8. Phone charger: So you can charge up while you’re scrubbed in.

9. Tape

10. Forceps: Useful for removing packing. (Make sure to discard or clean after each use.)

11. Lunch!

12. Highlighter and pens

13. Gum: For post-call morning breath.

HELLO, Bimanual Exam!

8:00 AM - Physical Diagnosis lecture.

Yum.

Go-To Questions

And now, what you’ve all been waiting for: a post about the most important part of shadowing—asking questions! Starting right now, ask as many questions as you can. All the time. Forever. (Just make sure the doctor doesn’t need time to chart before blurting out 100 questions.)

Original artwork by Dalya Munves

For those times when a patient visit was really boring, or you couldn’t understand the patient’s accent, or you just go completely blank, here are some go-to questions to ask:

• “How prevalent is [that disease/anomaly]?”
• The ultimate go-to question. This can even be used for very common diseases. Just ask in a way that sounds like you want a statistic, like 52.3% of U.S. population has lower back pain (not a real stat, FYI).
• “If that medication doesn’t work, what would you try next?"
• To be used: if you just heard the doctor prescribe a drug.
• “How often do you personally see [that disease/anomaly] in your practice?”
• To be used: for less common diseases. Do not use for anything as common as Diabetes or you will sound stupid.
• “What is the differential diagnosis for that patient?”
• Warning: do not ask if the doctor already listed the Ddx for the patient during the visit. (So if you zoned out, don’t use this one.)
• “What tests will you use to determine the diagnosis?”
• Warning: same as above.
• If the doctor gave the patient a list of labs that will be ordered, ask how the specific labs will rule diagnoses in or out.
• “How did you rule out [XYZ Disease], since it also causes [symptom patient just complained of]?”
• To be used: for symptoms with many etiologies, but use with caution.
• Don’t ask, for example, “How did you rule out migraine in that patient with an axe in his skull?”
• “How do you determine the starting dose of [XYZ Drug that you just prescribed]?”
• To be used: ONLY if you already know a little about the drug or if it’s fairly common: a statin, Metformin, an anti-depressant, etc.
• If this is the first question you ask, 1 of 2 bad things will happen: 1) the doctor will think you’re trying to sound smart, or 2) the doctor will think your clinical knowledge is much greater than it is and he/she will start pimping you on all kinds of questions. Neither of these feels good.
• “Are there any major contraindications for [XYZ Drug that you just prescribed]?”
• To be used: same as above (if you already know a little about the drug or if it’s fairly common).
• “When you palpated her [body part], how did it feel different from a healthy person’s?”
• To be used: if the doctor found something important during the physical exam (enlarged liver or spleen, for example).

This list is by NO MEANS all-inclusive. I’m sure I’ll think of some other good questions in about 5 minutes. But it’s a start!

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As always, please contact me with any comments or questions. :)

I Did It!

As usual, I am amused by what makes me happy as a medical student. Today I had my first clinical assessment: I was videotaped performing a comprehensive physical exam.

I didn’t forget any of the checklist items and my Standardized Patient (basically a paid actor) was very nice, but what am I most excited about? That I managed to palpate his femoral pulse without accidentally assaulting him. See the image below to more fully understand the awkwardness of this fete.

So I’m feeling pretty awesome right now. 

Any pain or tenderness? No? That’s right! Cause I’m an awesome [future] doctor!!!

(Photo credit: Lippincott)