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10th November 2008

maybe i can

Today was one of the few times I have really enjoyed clinic. As I mentioned, I’m rotating on the spinal cord unit during the morning and in the afternoon, I work in the neurology “specialty clinics.” Multiple sclerosis on Monday, general on Tuesday, dementia on Wednesday, movement on Thursday and seizure (if I’m not post-call) on Friday. The nice thing about these clinics is that there’s only one or two attendings and I can take my time on seeing the patients, because they are also seeing their patients. This afternoon, I saw one patient, a new diagnosis, and got to spend my time going over all of their symptoms, exploring the impact that the diagnosis is having on their lives, treatment, side effect, shown them the images of their brain, etc.

For once I didn’t feel pressured to rush through the history and physical, knowing as I interviewed one patient that the next two patients had arrived already and I was 20 minutes behind and I still had to staff the patient and the attending see the patient and then put in orders, explain again what the plan is, go through the side effects/how to take the new medications, remind again what the plan is, and point them to the front door. Is it any wonder that I sometimes overlook something on the physical exam or don’t ask if their great-aunt twice removed had seizures as a kid? Today, I got to focus on the subtleties and for once, really understood the pathophysiology of what the patient was presenting with.

I’ve been frustrated whenever I’m on the neurology side because I feel so far behind every one else; that I can’t seem to grasp the knowledge base that I need so badly so I can adequately take care of my patients. I’m mortified on a weekly basis when my attending asks me for my differential diagnosis and I can’t come up with it; and I realize that it’s because that above is how I learn, and I don’t get the chance to do that.

I’m off to bed. I’ve been so exhausted recently and it’s my own Tuesday morning clinic tomorrow, which means back to the nightmare. Only 7 more clinics.

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