Tuesday, October 23, 2007


Hold on to your pants! It's time for outpatient medicine!

The previous 3 weeks of my pediatrics clerkship was spent as a member of a team of doctors caring for sick kids in the Seattle Children's Hospital. As a medical student, I cared for 1-3 patients at a time, was responsible for all of their medical needs, including: deciding which labs to run (to either monitor progress or figure out what is wrong), following up on all of the tests and diagnostics, and deciding whether the kids are well enough to go home. This was surprisingly busy, since the kids are complex, and as medical students, we spend our days committed to a number of other tasks like rounding on the teams' patients, learning from case presentations, attending didactic seminars, going to med student afternoon teaching and finishing up all of the paperwork for patients' charts. The upshot is that I worked from 7:00 AM until about 8:00 PM. That time could probably be cut down if I know more about what I was doing - but I have all year to boost my efficiency!

Yesterday, I started the first day of the outpatient rotation. It is at this cool clinic in Seattle's Central District called Odessa Brown. It was pretty slow yesterday. I observed 3 well-child checks and didn't do any charting. There were only two providers seeing patients. Today was a different universe! Four providers and 2 medical residents were in clinic. Each of them had 4-10 appointments. This meant that almost every exam room (8 of them) was full. And today, it was up to me to do the history and physical exam on 5 patients. Or was it 6? Either way, having only been used to 2 kids at a time, I think I can be pardoned if they all ran together.

There was:
  • boy with funny lip rash
  • 2 month old boy for well-child and a bunch of shots
  • 9 year old girl for a checkup
  • 4 year old asthmatic with a head cold
  • 2 year old boy with sickle cell and ear infections
So I guess it was five. That doesn't count the other patients who I merely observed. Fortunately, I just used check boxes for the well child visits, but the sick kids each needed a note. So for me, it was a sprint to the finish. Complete with the damp underarms. On the wards, I got used to having an hour to finish my complete note; now I have 15 minutes.

Everyone works like mad for 9 hours and then at 5:30, I was the last provider to leave the office.


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