Last week, I had a third year medical student shadow me in the office; something I hadn’t done since leaving my old practice in New York City. Having a medical student changes your day significantly – I find I may be more formal, I spend time filling the student in on a patient’s history, and explaining my thinking and the science behind each case. My first thought at having a student again was – there is no way I’m going to be able to stay on time!
One of the things I love about Internal Medicine is the variety of illnesses I see. While some days feel like I saw the same person 10 times, explaining each person to a student reminded me of the story behind the “same diagnosis” – what makes each person unique. She asked me why I made a choice to treat one person in a particular way and another differently – because all people are different and have unique features that need individualized treatment.
Our second patient was an older man with swelling in one of his legs. We discussed the usual suspects – too much fluid, heart failure, trauma were all reviewed. We also discussed a blood clot (known as a DVT). As we went through his story and medical history, we decided that it was important to rule out a DVT – the risk of missing it made the decision to get a sonogram on his leg easy. Later that afternoon we got a call from the radiologist and indeed there was a blood clot in his leg. Now, when I was training, that call would have triggered a 3-5 day hospital stay while his blood was thinned. But on this day, it triggered a call to the pharmacy to start a pill and schedule a follow-up appointment a few days later.
The rest of the day was similar – hypertension, diabetes, cold symptoms, until our last patient. A woman had a bat in her house and had read that people may need to be treated for rabies even without direct contact with the bat. It turned out, as it usually does in these situations, my student had reviewed this topic recently and was able to teach me – in the situation we faced – we could reassure the patient that no treatment was recommended. I got to teach my student, and she taught me.
Later that week I traveled to New York City to attend a conference on Cardiovascular Risk Management. It was my first trip to my old hospital since moving to Arizona. Reconnecting with friends and colleagues was great and seeing how NYU Langone Medical Center has finally begun to recover from the devastation of Hurricane Sandy was heartening.
So by returning to my roots over the past week – teaching and learning – I feel refreshed. What seemed old is new again and the stresses of uncertainty in health care gives way to the art and science of helping people lead healthier lives.