this morning marks an important occasion: i'm heading into my very last continuity clinic. almost every week for the past 3 years, i've spent a half-day at the duke peds primary care clinic at roxboro street, or "the rox" for short.
"the rox" is a buzzing building in north durham that houses both attending-only clinics and house-staff (resident) clinics. as residents, we see mostly medicaid patients (with the random private patient thrown in -- these are typically parents who wanted a shorter waiting list and didn't mind seeing a less-experienced physician!). it's quite an interesting population, with a lot of ethnic diversity. we also get quite a few medically complex patients out of the duke system (NICU grads, for example).
when you start clinic as an intern, it's scary how little you know! but for the first 6 months to a year, the attendings go into every room behind you and fill in the gaps. little by little over the remaining two years of residency, your schedule expands and the supervision lessens. this year, i've pretty much only had attendings see my patients when i've asked them to (which i do any time i have a question about anything, want another set of eyes on the patient, or get a vibe from the parents that they just need the reassurance of an 'older' doctor!).
i'm going to be entering fellowship next
and that -- well, that's amazing to me! i am happy to be able to say it, and mean it too. so, i thought it would be fun to share some of the pearls i have picked up along the way . . .
top 10 things i learned in the primary care clinic
10. customer service is key. if you enter the room smiling with the aim of pleasing your patient/family, things will always go better.
9. no matter what you do, 18 month olds are never going to like being at the doctor's office. just get in and try to distract while listening to the heart/lungs before the waterworks begin.
8. good interpreters are incredibly important and worth their weight in gold (we have amazing ones at "the rox"!).
7. it's pretty much safe to assume all 14 year olds (and up) are sexually active until proven otherwise.
6. if you have a concerned feeling about a kid when you walk in the room, you should pay attention to it.
5. it's worth making that healthy lifestyle speech, even if it doesn't seem like anyone is listening sometimes.
4. don't send labs just for the hell of it or you will end up chasing borderline or questionable values. of course, test when it's indicated, but the most things you add, the greater chance you have for a false-positive.
3. don't mention shots until the END of the visit, particularly for those kindergarten-aged kids.
2. if you're running late, always apologize!
1. primary care pediatrics is not easy -- in fact, i think it's one of the hardest and scariest jobs there is! you're trying to find that sick needle in a haystack of well kids, with only minutes to do so! i have the utmost respect for seasoned primary care doctors.
and with that, i'm off to run before clinic! much to reflect on . . .
workout: 35 minutes elliptical (5 minute warm-up, 30 minutes post-strength-training), and abs/back section from the SSU week 3.
i'm still keeping track in my little st. maarten souvenir, as you can see above.
clean eating cookthrough: oh, there's nothing like a juicy burger in the summertime! this super-simple turkey burger (just ground free-range/organic turkey + chile powder + sea salt) with cheddar and mango salsa hit the spot for me last night.
served with a veg. rainbow . . .
impressive side view!
reading: 1 hour board review (derm)