Not much to report today. I spent the day observing, again. I can’t wait to finally get to actually perform the histories and physicals. I think it’s just been so busy that the NP doesn’t want to take the extra time to allow me to go in first and do the H&P. He seems the type that won’t take my word for it, and will go back in after me and redo the whole thing to ensure I didn’t miss anything — which is totally fair, but I think it’s making him less likely to allow me to do anything when we’ve got patient after patient waiting in rooms.
The most interesting thing I saw today was actually a psych case. I know — I have a thing for psych, if you haven’t noticed. It’s too bad I wasn’t more disciplined about blogging during my psych rotation. Maybe sometime when I have an exceptionally boring day and have nothing blog-worthy to write about, I’ll tell a psych story instead. Anyway, this was a 12 year old kid whose grandmother brought him in because he was doing poorly in school. Apparently he was already retaking fifth grade, and was failing it again. As we found out more of the story, it became increasingly obvious that this was a kid who was just being shuffled around each day between his mom and his dad (who are divorced) and his grandmother. He had no structure and couldn’t even tell us what time he usually goes to bed. His affect was blunted, if not completely flat. The NP mostly talked to the grandmother, and I would have loved to have talked more to the kid, but it wasn’t up to me today. In any case, his grandmother said that his teachers told her that he just wouldn’t do work in class; while everyone else would get out their work in class, he would just sit there quietly. Now, I know we’re not supposed to look for zebras when we hear hoof beats, but I started thinking maybe early schizophrenia should be on the differential diagnosis. Flat affect along with avolition? Sounds a little schizophrenic to me. But in the endless search for horses with hoof beats and whatnot, it’s certainly much more likely this kid is depressed. So he was sent out with a referral to a child psychologist.
One other interesting thing I got to see was a classic case of parvovirus B19. This was a six or seven year old kid who came down with fever a couple of weeks ago. The fever was accompanied by body aches but no other real symptoms. For the past two weeks, she’s just had a kind of waxing and waning of the fever and body aches. But the dead give away was the characteristic “slapped cheek” facial rash:
Poor kiddo. Good news is, the rash doesn’t hurt. But (like most viruses) this is not a treatable disease; you just have to wait it out.
And for our Bad Medicine moment of the day, a child was sent to us for a pre-op visit for a dental surgery. This may seem innocuous enough on the surface, but basically this is the dentist refusing to accept responsibility if something goes wrong during surgery. Pre-op visits are meant to prove that a patient is stable for surgery. Logically, one would think that is the responsibility of the person performing the surgical procedure. However, this dentist wanted the pediatrician to do it, which makes little sense, since the pediatrician is not even familiar with the procedure in question. These are the things that make medicine so inefficient and expensive. This could have all been done in house before the surgical procedure (especially considering the surgery was to take place at a hospital!), rather than involving another unnecessary doctor. This just brings in one more person to be liable if something goes wrong — passing the legal buck. This dentist told the patient that it is his or her policy to never perform pre-op clearance. How convenient — that’s a great way to make sure there is always someone else to blame in the event of a complication during surgery. And now I will climb back down from my soapbox.
Other than that, it was all coughs and colds. There is a nasty virus going around. These kids will get a fever for a couple of days, along with your typical symptoms of sore throat and cough. Then it seems to turn into a bronchitis with a cough that hangs on for a couple of weeks, along with sinusitis and/or gastroenteritis. Lovely, huh? I’m a little scared I’ll come home with this little bugger, but here’s hoping I’ll survive this rotation without getting sick. All of my friends who have already had this rotation have told me that they got the worst sicknesses of their lives during this rotation. Don’t worry though, if I get sick, I’ll regale you with all of the gory details and my treatments and whether they are effective. Yes, I will be your illness guinea pig. Stay tuned.