Pre-Day to Day Two : Internal Medicine and Otolaryngology

Hello Again,

A lot has changed since I last wrote. I am no longer residing in Scottsdale Arizona underneath the safe roof of my parents; instead I have relocated to Lecanto, Florida, a small town just outside of Tampa, and am currently living with my aunt, uncle, and their three kids. I arrived on February 2nd in Florida, and I immediately began work in a new environment at a foreign clinic. It has been a big change, what with the time shift, the cold weather, and the new people I am adjusting to living with. But, it has been a worthwhile experience with all the people I have met and all the knowledge I have gathered in the past 5 days.

Although I stated previously in my methodology that I would first give the doctor, whom I was shadowing, a personality test, I decided against it. As an alternative, I have decided to wait to give a personality test to every doctor I shadow, until I have made most of my clinical observations on their doctor-patient relationships. The reason behind this decision is to avoid the bias that I might have in my clinical observations of their relationships once I find out what career was supposedly for them.

Day One:

On my very first day at the clinic, February 4^th, I began shadowing a doctor, who we shall call ‘Dr. M’, whose specialty is in Internal Medicine. Internal Medicine, according to Princeton University, can best be described as “a branch of medicine that deals with the diagnosis and (nonsurgical) treatment of diseases of the internal organs (especially in adults)”.

Today, I chose to record interactions between Dr. M and her patients, the environment that Dr. M must deal with on a day-to-day basis, and the diseases I encountered

The population that comes to visit Dr. M is primarily between their early 50’s to their late 90’s, most of them had at least spent 4 to 12 years in a division of the United States Military, and the majority of her patients were from the Frost Belt (Minnesota, Wisconsin, Michigan, Indianan, Ohio, Pennsylvania, New York, New Jersey, Massachusetts, New Hampshire, Vermont, Maine, Connecticut, and Iowa). Her usual procedure was to ask if the patient required any prescription refills, check his or her blood pressure, check the abdomen region for irregularities, and then move onto what the patient wanted to discuss. At this clinic, the doctor required almost every patient prior to appointment to have a blood work done, so that she could check cholesterol, blood glucose levels, and kidney functions. Throughout all appointments, she was warm, understanding but firm, and remembered almost every single thing from previous appointments, such as medical and superficial facts about the patients from their kids’ names to their pets’ gender. During all the appointments that I was given permission to witness, at the patients’ digression, I was consistently reassured that she is “one of the best” and that I “could not learn from a better doctor”. In the course of the day I was able to witness the effect of radiation therapy to the eye, the side effects that dementia wracks upon the human body, and the administration of Vitamin B-12 and Prednisone shots. I was also able to see the Dr. M diagnose a patient with Post Traumatic Stress Disorder (PTSD) and Shingles.

            Through the observations that I recorded on my first day working at the clinic, I was left with more questions than answers. I know that a personality test is supposed to analyze certain elements of the human essence and predict how they would fair in stagnant environments, but do personality tests accurately predict success in unpredictable environments like that of the medical field or even the education field?

Day Two:

            On Day Two, February 5^th, of my project, I traveled to the clinic by way of my aunt’s car. I again was shadowing Dr. M, but I also was given the opportunity to shadow an Otolaryngologist (A Head, Nose, and Throat doctor), who we shall call ‘Dr. V’.

            The questions that plagued me on my first day of work revealed themselves once again while I was making clinical observations of the relationship between Dr. M and her patients, as well as Dr. M’s interactions with her staff.  On the second day, Dr. M was once again warm hearted and nurturing towards her patients, but the second time around I was able to see the actual human being behind her persona. Dr. M is spread much too thin in her clinic, in addition to her regular 36 patients, she must also make time for the walk-in patients which was about 20 that day, as well as patients who simply come to ask questions about medications which was about 8 that day. That is a total 64 patients in her clinic, this is not inclusive of her nursing home patients and her hospital admitted patients. On top of the 64 patients that she treated that day, she also had to fill out the corresponding patient files, lab requisitions, and prescriptions. Throughout this chaotic day, I was bothered with the question of whether or not personality tests have factored in these chaotic environments in addition to personality typing.

             After finishing my shift with Dr. M, I left the Internal Medicine clinic and went to Dr. V’s clinic not to far from there. Dr. V is an Otolaryngologist who had offered me the opportunity to observe several surgeries. That day I was able to watch a tumor being removed from the ear, stitches being taken out from the forehead, and the cauterization of the blood vessel in the nasal cavity that had caused the patient to be sent to the Emergency Room due to excessive bleeding.  All throughout my time with Dr. V, I noted his relationship to his patients to be similar to that of Dr. M, he was very easy going, warm hearted but firm, and very knowledgeable. During most of the procedures he kept conversation with the patients, since their insurances only covered local anesthetics, which numb the area that is being operated on but does not render the patient unconscious. Dr. V attempted to alleviate their discomfort as well as entertain them. In addition to Dr. V and Dr. M’s similar doctor-patient relationships, they also had similar problems. Dr. V was also plagued by an excess number of scheduled patients, walk-in patients, nursing home patients, as well as the excessive paperwork and lab requisitions.  I was again bothered by the question of whether or not personality tests have factored in these chaotic environments in addition to personality typing.

While thinking about what a personality test was actually testing for, I tried to name all the factors of a medical environment that determines how very chaotic it is. The medical environment today is plagued by but not limited to: Medicaid, Medicare, Hospice, the Universal Healthcare Movement, Insurance Coverage, Nurse Training, and Patients (age, ethnicity, culture, gender, religion, etc.).  With so many factors changing thanks to political movements, legislation, and immigration how is a personality test able to say that a person is able to confront the medical environment there are so many outstanding factors?

I think I will end there with that question; too much information might lead you to question my sanity.

Thank you for reading thus far into my Senior Project,

Till next time.

Post Traumatic Stress Disorder (PTSD):

http://www.mayoclinic.com/health/post-traumatic-stress-disorder/DS00246

Shingles:

http://www.mayoclinic.com/health/shingles/DS00098

Internal Medicine:

http://www.acponline.org/patients_families/about_internal_medicine/

Otolaryngology:

http://www.entnet.org/HealthInformation/otolaryngologist.cfm