After the neonate exam session I had Wednesday afternoon, I had a pediatric one on Thursday at Texas Children’s and a genitourinary session yesterday morning at the Baylor Clinic – both of which were incredible experiences too.
Pediatrics is a field which I don’t see myself pursuing in the future but have much respect for nevertheless. The patient population has tremendous variability ranging from the quiet, cooperative pre-teen to the rowdy five year old who just can’t sit still. A colleague and I had the privilege of following a really cool gastroenterologist who, aside from guiding us how to conduct a comprehensive history and exam, provided us with some nifty “clinical tricks.” For example, kids tend to be extremely ticklish around the abdomen, so when performing abdominal palpations, place the patient’s hands on top of yours. That way, they can anticipate where you will be palpating. Next, when trying to determine if a child is wheezing, use your penlight like a candle and ask the patient to blow it out as fast as they can. Kids rely on forceful expiration when blowing out, say, birthday candles… so any signs of wheezing will become apparent. Also, because you never know how many exams you’ll have to skip because of noncompliance, there are some helpful things you can ascertain just by looking at the patient from across the room (this is similar to the neonate exam). For example, the redness of a patient’s lips correlates to their hemoglobin level. I sort of wish Baylor Med had an elective called “clinical tricks” where they teach these pearls of wisdom before beginning clinics in January. 🙂
The genitourinary session was formatted in a very different manner. We started by watching a brief video outlining the process of examining the penis, scrotum/testes, prostate, and surrounding structures in the perineum. We then divided up into groups of five and rotated through a series of exam rooms where residents/physicians taught us how to perform each of the aforementioned exams (including how to insert a Foley catheter) on plastic models. We ended the session by performing the exams on a standardized patient. While the genitourinary exam seems to invade one’s modesty, it’s incredible how much information a physician can elicit from a two minute examination. Does the patient’s prostate seem to be enlarged or have an irregular texture? Could be indicative of processes like BPH or prostate cancer. Is there a tremendous amount of discomfort in the left, posterior part of the scrotum? Could be epididymitis.
I’m really happy with how well organized and informative the three PPS sessions I participated in this week have been. Now it’s time to really focus on the material for this block – gastrointestinal and hard/soft tissues. I’d also like to point out that today’s date is 10/10/10. Hopefully this brings luck to both the Texans and the Saints in their respective games this afternoon! 🙂