A very different feel here compared to Cheha-town Peds. There it was fast paced, 2 minute dictations, crack-the-whip, sort through the viruses medicine. My patient presentations eventually got boiled down to: "It's diarrhea. They look good." Even in Scrippsville, if they walked in the door they got a Statin. A door prize that didn't require much thought or reason.
My preceptors here expect a much deeper and wider differential diagnosis. They also expect a little more evidence based approach. We actually use things like Framingham's Cardiac Risk Score. They want my notes to say things like "...due to lack of abd pain and blood in stool, we ruled out bacterial etiology of this patient's diarrhea although if symptoms persist we may order fecal leukocytes and occult blood studies." Their ortho exams entail more than their fingers hitting keyboards to order an ortho consult.
It's refreshing. And difficult at the same time. It's easier to practice loose and fast medicine and blame everything on how busy your schedule is and how the "real world" doesn't include a legit review of systems and lengthy differential. It's easier to keep the patient's sweatshirt on and call a specialist than to actually examine their shoulder.
And at the same time 85% of my patients speak only Spanish. So my brain is doing a bit of spinning right now. I am being humbled on multiple levels. From basic communication skills (come se dice 'blister' en espanol) to detailed pimping (what are the guidelines for phototherapy in newborn hyperbilirubinemia?)
I'll keep you posted. But for now, I'll be stoking that fire with a textbook on my lap. I've still got a lot to learn.
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