Well I don't want to call it early, but I think this month is going to be much easier than the NICU ever was, probably just as interesting, but I don't have to get up at 5 every day. I don't have to work 30 hours straight every 4 days and I'm not expected to save infants from the jaws of death (not that it happens much but one time it did was enough for me), which has got to be the most stressful thing about that job.
This job is a lot of sitting in clinic so far. The patients just mossy on in, I get to take my time reading their histories, and then I go in and examine them. I then step out and speak with the attending on what I found, what I think it might be, how I think we should test/treat for it. After that I punch out a note on the patient and then see another one. I REALLY like outpatient work, the pace is so chill. I think the hardest thing to do is "switch" your mind from inpatient thinking to outpatient thinking. On the wards and in the ICU's everybody is REALLY sick, otherwise they wouldn't be there. You get used to being really "aggressive" with your medicine. If you see a fever and a couple other signs and you jump all over it in seconds with CBC's (blood cell counting), Bcx's/Ucx's (Blood & Urine Cultures), CXR's (Chest Xray's), LP's (lumbar punctures), Abx (Antibiotics)...the list goes on and on. On inpatient you are trying to find out the problem and fix it...or at least keep it from killing them. Outpatient is the "Yin" to inpatient's "Yang". On Outpatient most of the patients are fairly healthy (or nothing is wrong with them at all) so your approach to medicine is WAY more conservative. You are still looking to fix their problem, but instead you gear down your methods. For instance you would never here this statement on inpatient, "Here I want you to take this medicine, see if it solves your problem, and I'll see you back for follow up in a four weeks" (on inpatient if you told a patient that they would go home and die). So my problem in short comes normally when I come off an intense inpatient month (like the NICU) into something much more laid back. I can't stop it, there is always this phase that takes me about a week where a patient will say something like, "I've got blood in my stool." My differential will immediately jump to the five worst things, I'll have about 20 different lab tests in mind to do and when my attending asks me what I think, I inevitably miss the obvious common and benign problems, like diverticuli (little pockets that some people have in their gut that can become irritated and bleed) vs colon cancer...and I'll think to myself, "DUH!!!". It's not a huge thing (I'd rather be watching for the big things and miss the little ones any day) but it's one of those adjustments I'm making right now. I'd go into more detail about my day, but I am dead tired - we just got done moving into our new house...we are "moved" in, but not "settled" (ie Everything is sitting in boxes all over the house)...but very soon we're going to be out of this tiny shoebox of a hotel room we've been stuffed into for over a month. I'm crashing.
Newbie Doc
