Gen Med 1--Almost Canada, VT

Well, week one is over. I haven't killed anyone, or even had a problem (other than feeling like a complete idiot my first day). My preceptor is really nice, but also expects me to work. (not a bad thing). Being nervous I wanted to observe on a few patients first (even though she would have let me go straight to it). After 3-4 we had a repeat complaint..."go do it". After that I would start most patients (except when we were busy) and go present them to her. There was one I had to go back multiple times to ask more questions (oops).

Yesterday was day #2 (keep in mind I work 9am-9pm). My preceptor had to recert in PALS, so I worked with a PA named Ben. Awesome teacher! After our first patient (knee pain) he had me practice orthopedic exams on him while it was slow. Once things picked up, I would go in, take the history, present, suggest possible meds/tx. I splinted, I did a digital block on a thumb (no sutures were need though), and felt like I learned a lot. I was hoping to suture a child that came in, but as soon as he found out he needed stitches there was a meltdown. Instead I held the head while my preceptor numbed and sutured the ear. Oh yeah, I saw an amazing case of hives...4 days, all over, benadryl did nothing. Very pleasant patient, encourage me to examine them fully. Then patiently waited for the prednisone script. Apparently this happens all too often. I also saw a corneal/conjunctival abrasion, it was pretty cool how the fluorescein is uptaken by the injured areas.

Today was really slow (avg of about 1 pt. per hour). So I did almost everything on my own first. Starting off was a broken 4th metacarpal from basketball. FYI bruising on the palmar aspect of the hand is a pretty good indication of a fracture. Splinted the kid on my own, and on his way. Then dental pain x2 (one was a broken tooth, half gone and could easily see the pulp), and I was also able to observe part of an evolving MI before the pt. was transferred to Burlington.

If you are coming up here, be prepared to see lots of dental pain and back pain. There is a high proportion of medicaid patients that come through the clinic, and many haven't seen a dentist in years (if ever). Also, lots of delayed treatment. "Oh, I flew off my sled (snowmobile) about a week ago and my hand still hurts." Even kids coming in with fractures a week later...one poor kid had a partially displaced metacarpal that had already started forming a callous...will probably need surgery because of the delay.

As a bonus, I was sent home early tonight. That is, after 11 1/2 hours instead of 12. Something to do with the fact we had seen 1 patient in the past 2 hours.