Wednesdays

Hump day. Given our schedule, this was aptly named. Once I get through Wednesday afternoon, the rest of the week is all downhill. The hump, though, is 4 hours of lecture - my worst nightmare (so, why again am I signing up for another year of school?!?). Lecture is what I so strenuously avoided the first two years of medical school. Almost every lecture was video captured, allowing me to watch all our professors at up to two times the speed. Some professors, who had especially slow, monotonous voices, could even get sped up to just under 3x. That saved time and energy (and allowed me to sleep in very often). But, here there is no more lecture capture. One o'clock to 5:30 pm every Wednesday is back in the classroom; and with only eight students, falling asleep is completely out of the question. No dark corners in which to "rest one's eyes."

One thing I've noticed as I've gotten older is that I can no longer sit still. I honestly think my attention span was a better when I was in 1st grade than it is now. I'm very fidgety in a lecture setting. I tap my foot. I move around. I rub my neighbor's shoulders. Maybe I rub my neighbor's thighs (at least Dan's). I struggle to pay attention. It takes all of my concentration to keep-on-keeping-on (which has gotten more difficult as the year has progressed). The good thing, though, is that most of our lectures are "case-based." This means that the discussion revolves around the presentation of a patient's illness, and we work though the evaluation and management together. That keeps me involved and engaged. PowerPoint, on the other hand, is a different story.

On another note, I spend each Wednesday morning in Internal Medicine (IM). IM is the backbone of medicine, and it's one of the most important third year clerkships (if not the most important). Every specialty, no matter which one we chose, needs to know their medicine. Makes sense, since that is the field of study for physicians. Therefore, it is the broadest in scope. I actually work in a practice that is Medicine and Pediatrics, so I get to add kids into the mix. Prevention, growth and development, diagnosis, and management: IM is all-inclusive.

IM is also the clinic where I get the most outside continuity. I have followed patients to psychiatric appointments, to surgery, and met a number of them in the Emergency Department. This has been particularly rewarding, since I get to spend quite a bit of time with them in the clinic as well. I only see a handful of patients each morning, which has given me the opportunity to get to know each patient personally. I have specifically worked on developing my skills for weight management, smoking cessation, counseling about lab results, and developing a differential diagnosis.

One of my patients, in particular, shows how the continuity experience is extremely satisfying. Over the past several months, this individual has stopped smoking, lost weight, improved his/her liver and cholesterol profile, and has accomplished all these lifestyle modifications without the help of pharmacotherapy. It has been a true pleasure working with this person, continuing to motivate and being so impressed with my patient's drive. Of course, this is not the course with many (or most?) patients, but it is wonderful seeing a patient reach their personal goals, with or without medication. You don't see this if you only spend 4-8 weeks in a clinic or in the hospital; there's not enough time for real improvement. I've seen this patient at least 4-5 times since the beginning of the year, and I always look forward to seeing him/her on my schedule. If I didn't participate in a longitudinal curriculum, would I ever get to have this experience in medical school?