It's been harder this semester to write on this blog. This
is what has happened in the program so far. Yesterday we had our first two exams
of the semester. We had our cardiology block exam in Adult Medicine and renal &
gastrointestinal exam in Physiology. It is harder to get back into the
groove of things, possibly because of the snow and cold weather here in
Winnipeg.
This semester the courses are a bit different and I find I have to
change my study habits. They throw a lot of information at you and I realized
that you can't memorize everything. The most important thing is to understand
the larger concepts and memorize only what you NEED to.
All our exams are on Monday this term and
we have at least one a week. Next will be our pharmacology exam coming up
Monday. It will be on epilepsy, antipsychotic, affective disorders, Parkinson,
anxiolytic and pain drugs.
MY EARLY EXPOSURE
We each get to shadow PAs and/or doctors at
different locations and specialties this semester. I've been at two locations
so far....
Cardiology - Two weeks ago I followed a PA
in cardiology for the morning. Being this would be my first encounter with
patients I was very nervous but we were told that we would only observe. I met
the PA I was to shadow and noticed from this rotation and the next that
everyone starts with a morning coffee :) Afterwards we walked towards the
cardiology ward and was explained the routine. We began rounding on patients.
The PA checks each patient on the ward and asks how their night was and if they
are having any problems breathing. On cardiology I noticed that we checked each
patient’s legs for edema
(swelling), JVP (jugular venous pulse to determine blood pressure) and also
listened to heart sounds. I was able to listen to one patient with arrhythmia -
I heard it very faintly but I noticed afterwards it was because my stethoscope
was on backwards :S. In Cardiology there are monitors in the hallway that has
the patient’s live EKG/ECG
(Electrocardiogram). This allows us to see the rhythm of their heart and other
cardiac problems. The rest of the morning was focused on charting, here the PA
recorded each patient interaction, reviewed the results from previous lab tests
and the changed or ordered appropriate medications. I realized how much “med talk” I need to learn. There are many acronyms. A few hours later the doctor came in and they
discussed about each patient and their plan. A patient I found interesting was
a 28 year old male who had a cardiac event (I don’t remember specifically what type). It makes you realize that at any
age something can happen. It actually just made me worried about my husband
who is at that age. :P
Deer Lodge - Last week I followed a PA at
Deer Lodge. Deer lodge is a center for patients who need continual care for
post-surgery/injury after primary treatment has been provided at another hospital.
This was an eye opening experience. The PA was hired to replace a health
medical officer (doctor) who left. The responsibilities this PA had was great and
made me realize how much PAs can do. From my memory, the PA was responsible for
two wards but also responds to code blues (emergency code- patient requiring
immediate resuscitation) and the only one on call some nights/weekends for 500
beds. The PA described the logistics of the hospital and we went through how to
admit a patient. I was also shown some x-rays and was told that it was also
their responsibility to interpret EKGs and X-rays because there aren't as many
resources and staff available. If anything remarkable is found on those tests
that can't be treated at Deer Lodge, the patient is transferred to the
hospital. While I was shadowing, one patient presented with blood in their stool,
low blood pressure and low heart rate. The PA went through the differentials
with me. I learned the tests needed to be done and what to look and watch for.
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I’ve learned a lot in the 4 weeks we’ve been back. We’ve definitely stepped
out from just learning the basic sciences and are now combining it with
medicine. Our classes are focused on our differential diagnosis, on what
we would ask in our history, on what physical exam we would do and on what tests
we would order. It feels like we our minds are changing to become medical
detectives. 
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