A toddler in medicine

My friend Aisha said some months ago that we were all like toddlers in medicine. That's how clutzy we are still with our tools, our interviewing skills, and our knowledge.

But it hit me cold yesterday how people expect me now to give them advice, be it fake patients or real ones at the doctors’ office. Both cases are un-scary in theory because, in the case of fake patients, they and I know that I really don’t know anything. And at the doctor’s office, the doctor is actually there, or follows me at some point to recheck my work.

Nonetheless this is frigging scary. That I, with my highly defective short term memory (make that short, medium, and long), with my profound ignorance of all things medical, shall give a piece of advice to a patient, just plain freaks me out. I realized this yesterday at the doctor’s office. I’ve been working with a pediatrician, and rather than have me follow her around, she semi-randomly picks 3, 4, or 5 patients and has me do their school physical. This was painfully shocking the first time, like when your dad throws you (you being a toddler) in the pool so you learn to float. Yes, floating is awesome once you figure it out. But struggling for air maybe isn't quite as cool. And that is definitely how I felt. "Sooo...you want me to go in there and ask them about school and nutrition, and check their heart and lungs? Err...right? Their reflexes too?" And panic, panic, panic (as I had had zero warning that I was going in by myself!). My face must have been hilarious. If my doc had more of a sense of humor and a little more than 8 seconds to spare, she might have laughed her ass off. But she didn't, and threw me in the room instead, mumbling something about a form. Turns out that I did check a heart, a pair of lungs, of ears, of eyes, of feet (after laying my patient down), and then I sat her back up to look at her tonsils, and then laid her back down to listen to her tummy, and then I made her walk and then I sat her back down to check her feet pulses and then I gave up and did not lay her back down to palpate her tummy. Yeah. Your doctor makes this look like she's doing 5 things when you get a physical bc she's so smooth and experienced. Get a cluzty first year med student to do it. It will look like the 20 things that she is actually doing, and the thing is that she still will have missed another 10 things that she was supposed to do. But hey, it was my first time in the water. Thankfully, there is a form that I found after I had done all this, and I was able to do a more normal interview, "how's your sleeping, any problems going to the bathroom, any changes at home, do you exercise, what are your mile splits, where did you get that awesome tattoo, oh yeah, do you have any concerns for the doctor today" (accurately implying that I am pretty much useless and all I do is relay the info to the doc). So at the end, I floated, not gracefully, not skillfully, but I did it. And after her throwing me in the water like this so many times, I have kinda gotten used to it. It's sure stressful and, albeit forceful, an extremely good way to learn.

Granted, the school physicals are usually uneventful and if there is anything that needs attention (lungs that snore, golf ball-sized tonsils, babies with fevers and runny noses), I will defer to the doctor. But they still ask me/tell me about their issues, and I still need to be able to hear that snore in that lung, or to note that perhaps the size of that tonsil is somewhat not ordinary. And this is what makes me uncomfortable, because I am still a toddler who knows so very little...

The patients I am least comfortable with are babies, so fragile, their ears so little for me to come in with my otoscope, their heads so mushy still. On Wed, I did the check up of a 4 month old and a 6 month old. The exams turned out to be easy, but talking to the mothers was fairly stressful. They need lots of education/advice, especially if it's their first baby, and I just don't know! Do you introduce one veggie at a time at 6 months? at 9? 30 oz of formula a day? 40? mix it with cereal? Do you introduce fruit at 8 months? Or is it goldfish? pizza? And OMG. What boosters do you need at 6 mo? at 9? at 3? There sure are a zillion vaccinations for their tiny little butts to take.

But I digress. The point is, that despite being a wreck every Wed morning (in anticipation of the afternoon at the clinic), I also have a little bit of fun. Because, after all, that is what I wanna do when I grow up.