Immersion Phase Update: Primary Care (8/31 – 9/25)

This post is coming a lot later than I intended it to.  If the month of August was a whirlwind, the month of September certainly was too.  I really can’t believe it’s October now; this year has gone by entirely too quickly.

For most of the month, I was on the primary care rotation.  At Vanderbilt, each student is assigned to one clinic, which can be pediatric or adult and on-campus or off-campus.  I was placed in the Pediatric Acute Care Clinic (affectionately known as PAC), which I was familiar with from having spent two weeks there during my outpatient time on the Pediatrics core clerkship last June.  This time, I expected to have a bit more responsibility as far as which patients I could see and how I was expected to assess them, and that was certainly the case.

For this rotation, we had to make personal learning goals; one of mine was to become more comfortable with using interpreter services.  As a late second year student in PAC, I had not independently seen many (if any) patients and families who did not speak English, although several such families come through each day (I’ve heard PAC referred to as “United Nations Clinic” for this reason).  This time, when a patient whose caregivers spoke Spanish, Burmese, or Arabic presented to PAC, I signed up to see them myself first.  For Spanish and Arabic, there were sometimes in-person interpreters who would meet providers at the exam room, but for all other languages I had to learn to use Language Line, a phone service that is extremely helpful in clinic but that also comes with its own challenges.  Imagine trying to converse with a parent and an interpreter via speakerphone while the young patient and her siblings are crying or running around the room.  Or having the automated phone system misunderstand the lannguage you were trying to request.  One memorable moment using Language Line came when I tried to request an Uzbek interpreter for the mother of a patient.  I couldn’t get the system to understand what I wanted, so I took a nurse’s advice and asked for an Arabic interpreter, whom I then asked to transfer me to an Uzbek interpreter.  After several minutes, I was told that there was no one available who spoke Uzbek; I ended up going back into the room and asking the mother if she spoke any other languages.  We ended up conducting the visit primarily in Russian via phone interpreter.  Needless to say, I met my original goal and am now much more comfortable with requesting and working with an interpreter; now I want to learn a ton of languages (although I will say that using the Duolingo app on my phone has enhanced my ability to understand–but not speak–Spanish).

The variety of cases that I saw in PAC once again caught me by surprise.  I certainly diagnosed a number of “viral URIs,” but I also saw a few healthy children coming for annual checkups or ED followup visits, common childhood diseases, some rarities and a few cases where even the attending physician was unsure of what was causing the patient’s illness.  I kept a list within the electronic medical record of every patient I saw last month, and I plan to check on some of them every now and then to see what’s happened since I saw them.

For the primary care rotation, I also had to choose a patient that I saw in clinic, conduct a home visit, and write a reflection about it.  Despite some scheduling troubles initially, I found the experience quite rewarding.  We as physicians and trainees tend to forget that outside of the hospital, patients and families have their own lives, schedules, and priorities; it’s important for us to partner with the patients we see in order to deliver the care that they need, and not to simply make assumptions about their motivations or their concerns.

In addition to the busyness of the rotation itself, the 4th year class submitted their residency applications during this month!  At about 8am CST, countless medical students were refreshing the page of the application website, waiting to upload the information that would help launch them on the pathway to life after medical school.  As usually happens, the website crashed almost immediately and stayed down or “slow due to high traffic” for quite some time.  I’m sure many people across the nation panicked when they couldn’t submit their applications, but somehow I felt oddly joyful as I sat and waited for the chance to try uploading again.  I could physically feel a weight lift off my shoulders as I finally clicked submit, after the months of work and emails and meetings to get the separate pieces of the application together.  Now it’s on to interview season!

The week after I submitted my application, I took the USMLE Step 2 Clinical Skills exam (Step 2 CS) in Atlanta.  I’ll probably talk about that experience in another post, so stay tuned!

Another important event: College Cup 2015, potentially my last College Cup.  Last weekend, the four colleges of Vanderbilt Medical School competed for glory in basketball, water polo, Iron Chef, Twister, and more.  My beloved Chapman College won the tournament again this year, by only 10 points.  It was such a fun time, and I’m really going to miss this iconic part of my medical school experience.

Phew!  As you can see, a lot happened in September.  But no matter how challenging my schedule gets sometimes, I wouldn’t trade this for anything.


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