Priority #1: Just Show Up... Hopefully On Time

And so it begins! This week marked the beginning of "longitudinal" learning, and it did not disappoint. I flipped from Family Medicine on Monday morning, to sewing pigs' feet in our Emergency Medicine orientation on Tuesday. I raced from Internal Medicine in Arden, NC, to lectures on the liver and chronic diarrhea back in Asheville on Wednesday. An afternoon of Neurology here, Psychiatry there, and somehow peppered in library literature searching, meetings, didactics, and reading reading reading. As I drove back and forth from clinics to the hospital to the coffee shop and back to clinic, I did put a couple holes in the ozone layer; but hey, that's why I bought a manual Corolla. It was an exhausting five days, but extremely rewarding. I finally understand how "continuity" works, and I've started accumulating a cohort of patients to follow. Pamphlets explaining who I am, why I should be your personal medical student, what exactly that means, and how to contact me, were handed out to my "continuities" (although I reminded everyone that in the case of a medical emergency, CALL 911! - and same goes for the rest of you...).

"How does continuity work?" you might ask. Each preceptor has identified certain patients who would be extremely high yield to follow-up on throughout the year. Three reasons: 1) they said "yes" to having a med student, 2) they typically have chronic conditions or medical problems requiring multiple follow-ups, and 3) there is a lot to be learned (although every patient is a learning opportunity! - score brownie points to me for appropriate medical student response!). I, also, will identify patients throughout the year that would be good to follow. To ensure the continuity aspect, I typically walk patients to the front desk after our encounter is completed, and ask to schedule the next appointment for a day when I will be back in clinic. For example, if I see a patient Monday morning in Family Medicine, I try to make sure his or her 2 month follow-up is on a Monday morning when I will be there. My name is tacked onto their chart and BOOM! Continuity.

Additionally, I met a patient this week who needed an appointment with another service (NB: details have been changed to ensure privacy, as always). After our encounter in Internal Medicine, my preceptor and I needed to refer our patient to Neurology. Since I am on outpatient Neurology every Thursday afternoon, we scheduled the patient for a work up a few weeks later when I would be in Neuro clinic. Everyone wins: I can act as a advocate on the patient's behalf, the docs have better coordination of care, and I learn lots of medicine. The trifecta.

The big challenge will be keeping all these continuity patients straight (especially when answering phone calls... Ms. Jones who?). Per suggestions by former Asheville program students, I keep note cards on all my continuity patients, hole-punched into a ring, filed in alphabetical order. With a name, age, and quick notes to remind myself about specifics of each patient (e.g. "works at Carolina Cafe"), I can keep everyone straight. As the list grows, so will my roladex.

It may sound overwhelming, but I've found peace. The only way to cope with the new schedule is to make my own "weekly calendar" on an 8.5'' by 11'' standard sheet of paper with a template of the week's events. Each Sunday I print a new copy of the template, add my ED shifts, extra clinic times, meetings, and didactics. It keeps me on track so I know when I'm going to read for Family, Internal, Neurology, etc., when to lift, run, grocery shop, and do laundry. I happily express my OCPD with this sheet of paper folded and tucked safely into my shirt pocket. I will need this organization even more when I add Pediatrics (my preceptor was saving lives in Haiti this week), Cardiology (our first session!), and possible OR time with Ortho Trauma next week.

I had only one goal as we eased into conintuity... show up on time. If I could do that, the rest would be gravy. Ninety percent of life is just showing up, so I'm happy to say that I accomplished 100% of what I wanted to do during our first 5 days of chaos.

Next week's goal? Smile, and don't look so damn new.