More patients

So I finally got back into the clinic today, and though I got off to a rocky start, it went well. Since this is rheumatology, my patients were fairly typical. I saw a woman complaining of pain in her joints to start the day, and with some careful questioning, elicited a diagnosis of Sjögren's syndrome. The next patient was having similar symptoms, but mostly arthritic, with no obvious keratoconjunctivitis sicca, so we settled on just saying she has rheumatoid arthritis with some concerning blood work. She'll need regular follow-up, but for now she gets Tylenol and eye-drops.

The last patient was a procedure. He's got a Baker's cyst, a swelling at the back of his knee which causes some pain with walking. So the treatment is to enter the knee from the front with a large needle (after anesthetic, of course), drain out what you can, and re-fill the space with lidocaine and steriods. (The lidocaine numbs the area acutely, and then the steroids reduce the inflammation in the long term. It works beautifully.) After Dr. Sears numbed up the area, I got to do the rest of the procedure. It can't be a pleasant one under any circumstances, but I mangaged to pull if off without causing unnecessary discomfort, and my attending was pretty complimentary. About the entire day, actually. He said I did a great job getting the histories and physical exams, and (in a fairly typical attending move) tried to convince me that rheumatology was the way to go for a specialty. All in all a great start.

Rheumatology might actually be a lot of fun. It is a solely clinic/lab specialty, so you can't get called to the ER late at night because Mrs. Jone's has had a flare of her arthritis. And so the hours are great, and, according to Dr. Sears, this is great for a family. I don't presently have that concern, so maybe I'm not as wise as I might be, but the siren song of cardiology still calls to me.

Next up, walk-in clinic, pretty much where you go if you don't need the ER, but can't wait a week. No idea what I'll see, but the attending doesn't know either, so I'm not at too much disadvantage there.

But yes, the rocky start I referred to above. You know how sometimes the word, phrase, or question you need is just at the tip of your tongue? Now extend that to an entire conversation. I clean forgot what questions to ask, how to write down my findings, everything. I was writing a SOAP note like an H&P. Horrors. Of course, this is medicine, and it is easier to get away with that, but I was having flashbacks to Surgery, and heard Dr. Harb's voice saying "Stop using complete sentences, Nathan. I don't want complete sentences." I survived though, thanks to an understanding patient, and some appropriately timed thoughtful pauses.