MI in NoHo and other Fam Med Adventures

I love to talk in abbrevs. IMO*, its NBD* to shorten the way you speak. Medically, acronyms and abbreviations save lives by saving doctors' time.

So this entry is dedicated to all my abbrevs lovers out there. XOXO I'll use as many abbrevs as poss.

I am currently in my Fam Med clerkship. I was supposed to be in Boston rotating with a diff provider, but luckily I ended up rotating at Pioneer Valley Family Medicine (PVFM), a primary care branch of my fave hospital (Baystate, of course, see my last post...)

At one of my four desks in our new office!

PVFM is located in the beattiful town of Northampton, or as we like to call it, NoHo. In our Fam Med clerkship, we talk a lot about what "patient population" we get to work with. Some students are working in "underserved," or "hispanic," or "suburban" sites. My site's patient population is lesbian. According to my reliable source (Wikipedia), NoHo has the highest number of lesbian couples per capita than any other US city. Go NoHo! In my explorations and patient encounters, I would definitely believe Wikipedia's claim. I also spent two days with Spanish-speaking patients in Springfield. Between NoHo and Springfield I have seen people of all ages, genders, and sexual orientations, including a plump 9 month old baby boy and a sassy 94 year old woman.

Because I have been on this whole "becoming a doctor" path forever, one of my least favorite questions is "What do you want to be when you grow up?" When you are five, it's cute to say "a doctor." In college, people think (and say) that you'll never make it. In medical school, you start getting asked "What specialty do you want to do when you grow up?" This question is even worse, because I have no idea, and have to decide really soon. Also, depending on who you are talking to, and what your answer is, you get a lot of advice (or judgement) that you didn't ask for. I was with a good friend and classmate of mine last year, who, when asked what specialty he wants to go into, replied with, "I'm not sure, what is your suggestion?" I loved his strategy, and have used that answer a lot, but usually I say, "Probably Family Medicine with a focus on family planning."

PVFM put my face on the wall!

So as a probable yet undecided future family doctor, I obviously love my Family Medicine clerkship. It has a little bit of everything. In two and a half weeks, I have talked to patients about erotica novels, the color of their poop, what depression feels like, how their herbal medicines work, unexpected pregnancies, why they should quit smoking, the weirdest foods they ate in China, their biggest health goals, their end of life plans. Not to mention what they actually came to the office for... I like learning how to prevent disease, how to treat disease, and how to manage and distribute patients to the specialists they need to see. I also like to talk, and boy do we talk.

I lost my abbrevs for a bit, but they are back. In medical school, MI means myocardial infarction which means heart attack which means PANIC, BAD STUFF HAPPENING. In my Fam Med clerkship, however, there is another more positive and equally important MI: Motivational Interviewing.

MI means no nagging or lecturing. MI means letting your patient talk, and empowering them come up with their own reasons to make positive behavior changes that will benefit their health. MI means listening and reflecting the patient's ambivalence. For example, today, I helped a patient chose a day that he will quit smoking. It is not easy to get people to put down the cigs. How did I do it? MI.

It wasn't easy, but I listened and I listened and I listened, and then I summarized what the patient had said. "Sounds like you want to quit, and know it would help your health if you quit, but quitting seems like a pretty big challenge right now. What would it take for you to feel ready to quit?" And then the patient said, "You know what, I'm just being lazy. I quit before, and I can do it again. I already know how." So we set a date. BAM. He was MI'ed.

MI doesn't mean that my patient will actually quit on June 8th. But science says that the more doctors talk to patients about healthy behavior changes, the more likely they will make them. Tobacco use, diet and physical activity, and misuse of alcohol are the top modifiable risk factors for death and disease in the US. Taking the time to MI some patients is well worth it.

To wrap up my particularly non-sequitor discussion of Fam Med, MI, NoHo, and abbrevs, I want to share the way my supervising doctors write their notes.

Instead of writing (excuse the medspeak):
Head, Eyes, Ears, Nose, and Throat: Normocephalic atraumatic, mucous membranes moist, extraocular muscles intact, pupils equally round and reactive to light and accommodation bilaterally, bilateral tympanic membrane intact and reactive to light, bilateral sclera anicteric, no conjunctival injection

They write this: 
HEENT: NCAT, MMM, EOMI, PEERLA, b/l TM intact, b/l sclera anicteric, no conjunctival injection

I am also slowly getting better at writing notes about patient interactions, and I am rapidly getting better at translating my medspeak into medabbrevs. Good thing I came in with a strong background in the art of abbrevs.

(I meant to discuss public health and joy in practice, too, but got carried away with the abbrevs. Maybe next time?)







*This is for you, Mom: IMO = in my opinion, and NBD = no big deal

Baystate Pride

Time for a major update. I have MOVED to Springfield, Massachusetts for my third year of medical school.

So what is third year? Honestly, until it started I wasn't so sure myself. I've heard a lot of rumors about what it is like, and have seen former third year students wandering around hospitals like zombies in white coats. When I moved into my beautiful and humungous apartment in Chicopee with my new and awesome roommates, Nicole and Falafel (the cat, not the food), I got a peek of what third year might be like. The guy who lived here before us just finished third year. When we moved in he pulled a dusty dry erase board with a message for us down and smacked it onto the front of our fridge. He told us it was a message he got from the third years who lived here before he did, and that he felt the same way and saved the board for us. I hope that this wont be "the worst year of our lives," but just in case, we changed the dry erase board to something a bit more positive.

Yep, third year is supposedly "challenging." We rotate through 2-4 electives and 6 core clerkships of Family Medicine, Obstetrics and Gynecology (OB/GYN), Internal Medicine, Pediatrics, Psychiatry, and Surgery. Depending on the rotation, we work between 40 and at maximum 80 hours a week with doctors caring for patients, and then go home and do homework and read about everything we treated. We are expected to know everything, and to speed up health care. In reality, we know close to nothing and slow everyone down (or at least that is how I feel a lot of the time).

Luckily for us, Tufts had their first ever Orientation for third year this year, to make us feel just a little bit more prepared. We practiced placing catheters, drawing blood, suturing (photo of some of my first stitches - other than the ones I did on the Thanksgiving turkey this year...), and went over how to communicate with busy doctors. They like to call this communication style "presenting," and it involves using as many big jargony medical terms as possible in the shortest amount of time needed to convey the most important information about a patient to their doctor.

I. Love. Baystate. Ok, it may be really early, and I may not exactly be rotating INSIDE the hospital, but I love the mission (to improve the health of the people in our communities every day, with quality and compassion), the culture, the people, the ambiance, the je ne sais quoi. I just love it.

Lets talk Baystate. Baystate has won too many awards for me to keep track of, but if you want to see them (Mom, this is for you), dig into the Baystate Trophy Closet. I found the picture to the left in a Consumer Reports magazine - Leapfrog rated Baystate in the Top 10 teaching hospitals based on five key safety and quality metrics (readmission rates, complications, communication, CT scan overuse, and infections). TOP TEN!

Of equal importance to me (AKA a medical / public health student, not a patient) is that the doctors and educators and medical teams love having students here. They love to teach, and they take pride in the quality care they provide to their patients and the quality education that they provide to us. And that pride is clearly contageous.