As I complete my final month of clinicals, I find myself trying to explore those nagging insecurities that infuse me with this vague fear...
Yesterday I was trying to figure out why I find myself needing my preceptor so much--why I feel that I would be unable to manage a patient without her, and this is what I came up with: most of the patients I see have multiple complaints. Depending on the patient's way of describing what it is that's bothering them (I have a lot of non-english speaking patients coming from very different cultural backgrounds, or homeless patients with a very different level of education) I find myself trying to not only understand the gist of their complaints, but trying to frame what they are saying in a physical model that I can understand (ie, I had a pt who insisted that she had "meat" come out of her rectum--her initial complaint is of knee pain, and she's in her 60s and never had pelvic exam. She's here for a physical, and technically I have 20 minutes, though it takes me 40 just to illicit this information. Another pt who has frequent unprotected sex [never uses BC], multiple abortions, and no desire to get pregnant--she has been spotting daily for over a month, doesn't remember the last time she had a normal period. Is at the clinic for CC of back pain and routine PE--is totally shocked that we should do a pregnancy test, but also more concerned about her back)
I've heard a lot of providers talk about ways they set limits with patients regarding what issues they address at this visit. I can't wait until I feel comfortable with this, because my visits take so long at the moment. My question for those of you who have a little more experience--how are you able to set these limits and feel confident that you aren't going to miss something by not getting the full history of each CC?
kanzi monkey
618 Posts
As I complete my final month of clinicals, I find myself trying to explore those nagging insecurities that infuse me with this vague fear...
Yesterday I was trying to figure out why I find myself needing my preceptor so much--why I feel that I would be unable to manage a patient without her, and this is what I came up with: most of the patients I see have multiple complaints. Depending on the patient's way of describing what it is that's bothering them (I have a lot of non-english speaking patients coming from very different cultural backgrounds, or homeless patients with a very different level of education) I find myself trying to not only understand the gist of their complaints, but trying to frame what they are saying in a physical model that I can understand (ie, I had a pt who insisted that she had "meat" come out of her rectum--her initial complaint is of knee pain, and she's in her 60s and never had pelvic exam. She's here for a physical, and technically I have 20 minutes, though it takes me 40 just to illicit this information. Another pt who has frequent unprotected sex [never uses BC], multiple abortions, and no desire to get pregnant--she has been spotting daily for over a month, doesn't remember the last time she had a normal period. Is at the clinic for CC of back pain and routine PE--is totally shocked that we should do a pregnancy test, but also more concerned about her back)
I've heard a lot of providers talk about ways they set limits with patients regarding what issues they address at this visit. I can't wait until I feel comfortable with this, because my visits take so long at the moment. My question for those of you who have a little more experience--how are you able to set these limits and feel confident that you aren't going to miss something by not getting the full history of each CC?
-Kan