pap smear…no wait, colp…no wait, i&d…no wait, all three

that title, right there, describes family medicine to a tee.

i have been on the rotation for just barely a week, and mostly it confirms my desire to never do outpt medicine.  outpt medicine is torture, especially as a student.  even if a patient comes in for nothing, i still have to do a full onslaught of questioning and write-ups.  plus, you can’t focus on a patient’s one problem for that day.  since they’re there, let’s also ask about when their last _____ was (fill in blank with: mammography, pap, fobt, etc).  most of family is pretty boring to – it’s all run of the mill.  however, it’s early yet.  one of the pulls to fp is the variety, though.  for instance, they can do minor surgical procedures – sutures, wart removal, incision and drainage (i&d), etc.  today was sort of an example of such a day.

 as i waited around for my resident, the clerkship director came by because she would be seeing patients this am.   she sees me and tells me to work with her for the day (she’s a really good clerkship director because she’s always so involved).  the last patient of our afternoon is listed to be a basic pap smear.   this pap smear was actually due to be a colposcopy, which i had never seen before… this may not seem like much, but it’s pretty random that on day 3 i’m already seeing procedures like this.  (not to mention that on day 1 i got to swab for stds and do a pelvic on a woman [this involves putting fingers in a woman’s vajay]).  before we start the colpo, the doc notices a nodule on the labia and basically it turns out to likely be an abscess, which the treatment of choice is i&d.  so, in addition to seeing a pap and colpo on this woman, i got to do the incision and draining, not something i expected for a routine pap.  but that’s family medicine, you really don’t ever know what a patient is gonna surprise you with.

the resident also pulled me aside today to show me some scabies.  scabies are often an std, and people often know them for this, but a young girl came in with them.  it was a pretty clear cut case, but as the mom is asking about a note for her daughter, she asks that the reason not be put (the stigma as her reason).   this resident totally blunders and is like, no it has to be on there.  which isn’t the blunder, because the school may need to be aware of the severity of why she is missing class – what he didn’t explain is that while if other students knew, sure they would make fun of her, but then that means the school has broken hippa laws.  while the reason will be listed on the note, the school can’t share that kind of information.  instead he’s like – nope we’re writing it down.  dios mios.

 i also might add that i feel completely overwhelmed this week.  i am, as usual, completely overloaded.  i give myself way too many responsibilities, but they’re all things i want to get done.  sometimes i feel like a bipolar, starting a million projects and being unable to complete them.  i just need to take a step back and just knock these down.  it’s exhausting when i do this to myself.  my goal is to knock one out completely, one major one that has dragged out. we’ll see.


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