Don't Call Me Doctor...Yet: Interpretations and Muffled Noises

After the chaos of post-test celebrations, things returned to normal - eat, class, study, sleep. I am trying to add in some fun and some exercise for mental health, but its proving difficult. I did work out yesterday, though!!

So anyways, on Wednesday, I had my first Problem Based Learning (PBL). We had an introduction lecture on PBL last week that was sooo awesome! The professor used every type of teaching method possible in one hour, and had a glowing fluorescent disco stick that he used to encourage us during the lesson. He was also wearing a bowtie and a cowboy hat when we walked in. He had my classmates dress in different hats and write things on the board and shout out answers and more. It was my favorite lecture so far, and was a great way to lead into PBL

So PBL is basically a small group (5 first year students and one 4th year facilitator) where we slowly make our way through a clinical case and stop every few lines to discuss:

1. What we know (from the case)
2. What we want to know (questions we want answered based on what we know)
3. Problem List (known medical problems in the case)
4. Hypothesis (guesses of what the medical problem is)
5. Learning Quesitons (questions to look up to make solving the case easier)

So from a case on a 6 year old male presenting with fatigue, bleeding gums, and a sore throat our hypotheses were scurvy, overbrushing, a viral or bacterial infection, a clotting / blood disease, and an autoimmune disease. We later found out that he had petechiae all over his body, and we aren't allowed to look up what it is until next week. It is hard not to skip ahead to find out whats wrong with our poor patient, but it is cool to come up with different ideas, questions, and thoughts based on very few details and then more and more as we go along.

Throughout PBL we will have 6 cases. We can go through them as slowly or quickly as we want, and every week we each have to chose one or two Learning Questions to present in the next session. The facilitator just keeps us on track and encourages more questioning and thoughts. And the process is not about finding the exact thing that is wrong with the patient, but to come up with creative differential diagnoses and questions that we should ask when presented with certain things. I love PBL, and can't wait to find out what petechiae are. I'll keep you posted!

On Thursday I had interviewing yet again, back at the home for the elderly. This week we worked with interpreters, and for the first time had to do AN ENTIRE MEDICAL INTERVIEW. Which includes:

Chief Complaint (CC)
History of Present Illness (HPI) - What, Where, When, How long, Why
Past Medical History (PMH) - hospitalizations, surgeries, chronic illnesses, OB/GYN info, prevention
Social History (SH) - home, work, sex, drugs, smoking, alcohol, seatbelts, guns, violence
Family History (FH) - family members with diseases

Its a lot to remember, especially when you are trying to listen to the patient's answers and store the information to put in the chart later! ACK!

But using an interpreter was cool! We were instructed to set up with the interpreter next to us and the patient in front of us both. We were told to look only at the patient, and speak directly to the patient despite having to use the interpreter. We were also told to never speak only to the interviewer, and to assume that the patient can completely understand us (no side convos!). It was hard to listen to one person while staring at another, but I think it really made the person I was interviewing more comfortable. She was an adorable 72 year old Chinese woman who gave us all grapes and had very few health problems.

I did not study enough this week and am 8 lectures behind. Thats 16 hours of work. EESH!!!

PS: I got my stethoscope!! Its purple!!! I can't hear anything I'm supposed to yet, just a bunch of muffled noises...but its pretty cool and I can at least look official now despite the fact that I still know nothing of significance. Other than some really weird rare diseases and a lot about Trisomy 21 (Down Syndrome).