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Monday, July 23, 2012

Dermatology Elective

I completed my Dermatology Elective last Friday, July 20th.   I really liked my elective.  I chose this as my elective because I wanted to do something different.  I enjoyed learning about Dermatology but I felt it was a weakness that could be used in primary care.  I was working with a very popular and well-known Dermatologist, so I saw a great deal.  There were people who came from all over the US to see him.  The majority of the time I saw full body exams on patients, checking for atypical moles, potential skin cancers, and pre-skin cancers.  I did see some very interesting rashes, systemic diseases, and a lot of acne.  I was unable to actually see patients on my own because of his popularity, however, he was a great teacher and I learned a lot.
  A common complaint I  saw in the office is constant itch.  These were the hardest patients to treat, especially if there were no visual findings like rash.  Thankfully, we treated them all, and many times I heard the words “Doctor, you saved my life.” Itch is a horrible complaint to have and to live with.  Itch can be constant, spontaneous, or occur during specific times.  Any of the above can severely decrease a patient’s quality of life.  Many have developed scars, some in cosmetic areas, because of this problem.  The first step is to take away the insult to injury, if there is one.  This is simple, if there is nothing there to scratch usually people do not pick.  The next step is something obvious but hard to follow- if it itches don’t scratch it.  This is a very cruel thing to say to a patient.  It is impossible for a patient to not scratch even though they know they should not.  Instead of saying this say, "If it really itches apply gentle pressure over the area for a few seconds, but do not use your finger nails."  This relieves the itch but does not cause any trauma to the skin.  Using this technique may allow time for the skin to heal and for the itch to go away.  The last step was to give a patient some medication.  Many of you are probably thinking, this is so simple, it is.  However, many practitioners do not follow this and the problem persists or worsens.
Wednesdays were cosmetic days.  Here patients would get Botox, fillers, etc.  I think that a lot of people have a misconception about these products.  I know this because when patients came in for a consultation they brought up these views.  In Hollywood, these products tend to be over used and the individuals tend to look like they are from another planet.  In the office I worked in, the Doctor emphasized that fillers and Botox should be done to make a person look fresher but still look like themselves.  The common medical practice of start low and go-slow is key, do not overdo, always under do when it comes to cosmetics.  You can always add more later.  Many patients that came in for consultations were apprehensive, not vain.  Each person left looking like himself or herself, just less worn down.  Throughout the process we would give the patients a mirror to help alleviate any anxiety that they were being altered.  We would mix lidocaine with some of the products to make the experience less painful. Comfort is key.  There was not anyone who was not happy with the results.  Radiesse, is the product we used the most often because it is a natural product that stimulates a person to continue to make their own collagen.
As it stands, I have 4 days until graduation!  This means that the next patients I will be seeing will be my own.  I am currently applying for jobs in Family Medicine, Pediatrics, and Dermatology.  I hope that I get some bites.  Please continue reading, I have been told that I am able to keep this blog.   I will be the alumni PA blogger.  I look forward to writing about job seeking, working as a PA, etc.  Thank you to those who have continued to read my student blog, I can’t believe I have 4 more days of being a student.

Wednesday, July 4, 2012

Comprehensive Review Week

            One of the most dreaded weeks in PA school is our comprehensive review week, or as many of us call “Hell Week”.  Essentially, we get lectured for three full days about everything we learned in PA school.  At the end of that week we have a two part 250 question written exam, clinical skills testing, and a patient encounter.  The clinical skills testing portion is on the skills we learned during the school year.  Many of you may remember my entry on splinting and casting. This was one of the skills we had to perform.  Others were injections, suturing, catheter placement etc.  The point of testing on this section was to show our skills in these areas that we had performed on our rotations.  For myself, I felt very comfortable with venipuncture because I done this skill about 15 times a day in my OB-GYN rotation.  There were other skills that I felt not so comfortable with. 
The patient encounter was the one that my classmates and I worried about the most.  I am sure you are all thinking, “Jen, you have seen patients all day long and will in the future, why are you worried now?” I can tell you all that I do feel comfortable with diagnosing and treating patients; however, when you are being watched and timed it can be nerve wracking. There was a 20-minute time limit to do a full history and physical exam, and then 5 minutes to present your findings, assessment and plan to the grader in the room.  My experience with this patient encounter was better than expected.  In the real world I know I could have done better.  It really is true that you know more than you think you know.  I think that I delivered one of the best presentations of a patient that I have ever given in my life.  It was short to the point and I had the correct diagnosis and treatment.  Rotations really prepared me for this. Sure, I made some mistakes as far as adding additional physical exam components that were unnecessary to do.  These were due to nerves.  Even now I still laugh about some of the things I did that day. 
            In the long run, comprehensive week is finished.  What is even more bitter sweet is that these were the LAST tests I will ever take in PA school.  At the end of the day, all of us went out to celebrate. The only thing I have left now before graduation, 23 days away, is my dermatology elective and presentation.  I am so excited!! Happy July 4th everyone!

Behavioral Medicine Rotation

I finished my last rotation about 3 weeks ago.  I really liked it.  I was in a center working with patients who struggle with alcohol and drug abuse and dependence.  At first I was not looking forward to this rotation, but it grew to be one of my favorites. I did not do a lot of this rotation; I mainly observed psychiatry appointments and group therapy.
The psychiatry appointments were interesting; they were either medication checks or psych evaluations.  Many of these patients who I saw in the psychiatry appointments are some of the same individuals that I saw in-group.  One thing that I realized is that a lot of patients feel comfortable in either a group setting or individual setting but very rarely both.  There were patients who did not talk during group who really opened up to their psychiatrist. 
Group therapy I enjoyed the most because you get to see a wide variety of stories and experiences.  Each person, while different from the next, over time found the similarities in their addiction and helped each other through hard times.  Many of these patients are at different stages of their treatment, each with a different substance of choice.  Many have additional documented psych issues as well or even other addictions such as gambling or retail theft. It is amazing how some of these individuals bring each other up and are able to reveal such emotional struggles to their peers.  A lot of the stories I have heard are tough to hear: sexual abuse, physical abuse, enduring the loss of friends/family, and personal experiences of being shot/stabbed.  It is amazing to see the stepwise progression of a patient in treatment. One of the quietest patients began to open up during my last week, he said "I have no money in my pocket but I have a full heart and a strong mind."  Another patient who sold drugs for years and was known to people throughout the area for doing so stated,“ How do you become someone new when you are essentially famous to all the people around you.” One of my favorite days during group therapy was the day everyone on in the room talked about their families.  Many have children.  They spoke about how they are now able to spend time with their family and put them first.  One man talked about seeing his daughter walk for the first time and say dada.
I was very sad to leave this rotation and the people who I became close to.  While I am certain that I will not be going in to behavioral medicine as a PA, I do know that I will take this experience with me when I practice medicine. Having seen first hand group therapy and psychiatry appointments I can give an accurate account to patients about these experiences and what to expect.  I also can see how much improvement it can make in someone’s life.  At the same token I have seen how many friendships have been made during this experience.  Addition and dependence is a struggle that at times is dismissed by the unknowing public.  For patients with these problems finding a welcoming community of peers really makes a difference.