Friday, August 10, 2007

Out, Patient!

I used to love OPD postings, but this is overdoing it. I mean, OP every single day? It's getting monotonous. The main problem is, I think, that we haven’t been divided into units. We don’t know any of the teachers that well, we don’t get to know the patients, we don’t see any procedures being done, and, most of all, we don’t get that feeling of belonging somewhere. It’s 4th sem paediatrics all over again. That was one of the horriblest postings ever, with the possible exception of Ob-G. In paeds, the problem was similar, we weren’t divided into units, but there it meant we’d never set foot in the OP’s. Ward 4/5, day in and day out, screaming children, hostile mothers. And no ward classes on most days because the teacher was busy. I attribute my dislike of paeds to that dratted system.

I still enjoy the OP, the different variety of cases we see in a single day is amazing. It’s just that I’d like to rest my feet once in a while. I can just about feel the valves of my veins slowly losing the war against gravity.

The ophthal OP is kinda easy. As my cousin, an ophthalmologist, said, in ophthalmology, what you see is what you get. Hordeolum, conjunctivitis, cataract, pterygium, corneal ulcer, and a lot of other conditions are obvious on torchlight examination. I’m becoming something of an expert at distinguishing pseudophakia from aphakia. Oh, who am I kidding? A monkey with a torch can do that. I'm such a fake, ya.

I haven’t presented a case yet. Will do soon. I like taking cases, and I don’t mind presenting them, because I know I’m not that bad at it. I’m not great, but hey, that’s what I’ll be doing for a good part of my life in the future, and I might as well learn to do it right, if not well.

On the subject of case taking, just how do they manage to reach a diagnosis so quickly in an OPD? It’s just not ophthal, it's the same in medicine or surgery or paediatrics, or even one of my least favourite clinical subjects, orthopaedics. How they discard the irrelevant information, how they know exactly which leading questions to ask, and voila! We have the diagnosis. This rarely fails to amaze me. Someday, I’m going to do this, become a great clinician. Even if I have to open my textbook and actually read.


Tys on Ice said...

Iam all eyes on this one...abt the reference of the monkey with a torch...thts wht my ent specialist is ...he seems to make a lot of ummmms and ahhhs while hes looking down my throat ...iam just glad that hes enjoying himself.

Adorable Pancreas said...

Hehehe... you probably have very pretty tonsils. ;)

Bullshee said...

Ok, I like where you're blogs going!Its the first Doctor blog I've seen....but you gotta make the abbreviations understandable to the aam junta. i've got a bro studying for medicine, but still i can't call him up every time i need to know what OPD means! :D

Bullshee said...

i always mix up between "you're" and "your"....ignore it as you would a microbe... :)

Adorable Pancreas said...

a)Microbe blasted with antibiotics. :P
b)People actually read my blog! Thanks. A million dollar cash cheque coming your way.
c)Abbreviations. here goes:
OPD: Out Patient Department
OP: What we call the OPD here. eg: We have OP posting today. Well, everyday, sadly.
Ob-G: Obstetrics & Gynaecology (Hate the subject. Hate it. Hate it. Hate it. Ah, shoot me now.)
d)Thanks for visiting. Do come back. The cheques is in the mail.
e)Do I sound desperate? Because I'm not. Really.

ToOothlEss WOndeR! said...

there are quite a few doctors around this block, but they all talk about cases, and people.. not diagnosis.. i've always wonderde what goes on inside a medical college.
i've had a sister who'd bring bones home, so i guess you guys do something with them bones, but that's where my understanding of it ends.

on a slightly different note, dont you guys get sick of the smell of the antiseptic lotion? and alcohol?

i think it's time they made better smelling hospitals! :)

Adorable Pancreas said...

My mom refused to enter my room for the whole year when I lived with the bones.
And the antiseptics mask more gruesome smells, so I learned to love it. :P

S said...

Commplements again on your good post. OPD posting are the place you dread when you are a student and regret not using it to the maximum after you start practicing on your own. You dread it because of the number of patients you have to see in not very comfortable consulting rooms, with only a dozen (Whatever is there in the GH formulary) medications you can prescribe to. But look at it from another angle. For the patient you are their only savior. If they could have afforded private set-up, they will not be coming to GH. Once you start practicing, you realize that you are on your own. You are responsible for what you prescribe and what happens to the patient. It is not like in college; the patient comes and sees someone else in the OP at another time. It is one to one. He/she holds you responsible. And I know in Kerala, the patients can turn violent, if they think something went wrong. So it gives you the courage to practice alone and gives the wisdom to reach correct / near-correct diagnosis fast. What we regret is, to have spent more time listening to all those murmurs and crepitations. These you cannot learn from a book. The more you hear the better / more confident you are at future diagnosis. And the difference between hearing properly with your stethoscope and just hearing for namesake is just probably an extra-few seconds. Alas many of us realize it only when we are out into practice. In tamil there is a saying ‘Saivana thirundha chai'. (Whatever you do, do it properly). All these i can say, because i am out of the college and can look at it from different perspective.