Thursday, June 18, 2009

"They get a little nauseous, a little radioactive, but they tolerate it well, they don’t glow in the dark." Prof LaB.

I think I had the best day that I have had on the island so far today. I did not have to work with the preceptor. I got to work with an active duty PA. He knows his shit and will actually tell me things. I listened to a set of lungs that had actual pathology in them. I never thought I would be so excited to listen to someone tell me about how they have had a fever and headache for two days. Ahhhh. I LOVE family medicine.

This is “community medicine” for me. This system is a failure of everything that is community medicine. I struggle for hours and hours trying to understand how I am benefiting my community by doing what I am doing. I still don’t understand.

Much of the rest of this job has been to do occupational medicine. What that means is to do return to work notes, annual physicals to check on lung cancer. Its odd because if you order a CBC and Lights on 500 guys, how many abnormal results do you think you will find? I love waiting to find out what my preceptor will use as an explanation. My personal favorite so far is “You have 125 sugar in your urine because you drank two regular cokes two days before the urine was tested.” We did not have a blood sugar on him, but I remember from some lecture about there needing to be more than 300+ glucose in the blood before it will start to spill into the urine. Uh, I don’t think that it is good to have sugar in your urine. Just say’n.

Today was very different. The PA that I was working with was fantastic and knowledgeable and no shit was even willing to talk about pathology and why he thought what he thought. Imagine that, explaining your thought process and perhaps even offering tips on how to improve your exam to be more precise.

Often at the end of the day, many preceptors will ask you if you have any questions about what happened that day. Vast majority of the time I say no. Granted, I sit there and look like I am thinking about it, and nod my head like I am running through every person that we saw that day and thinking about them. But its all a show. I don’t ask questions.

Today, I asked questions. I asked questions about life as a PA in the Navy. I asked about job ideas, about recertification, about the roll of the combat PA, about career progression, about life. It was good, I had to stop myself after a couple questions and check to make sure that he was still really OK with answering questions.

It was good. It re-affirmed my desires to do what I am doing. I want to be a PA in the military not for a specific goal, but for a life goal. I feel that we as citizens of the US have asked our men and women in the military to fight our wars. I feel that we as the medical community have a responsibility to share some of the risk of that fight. To take the risk so that someone can come home who may not have been before my interaction with him/her. THAT is a noble cause and I will pursue it.