This post should be about Psychiatry since that is what I am writing next week. But… it’s not.
There is a Maties Community Service Clinic this weekend. I put my name down as volunteer about 6 weeks ago, but cancelled because of that darn test. However, almost all the volunteers also cancelled (for various reasons), so I decided to go anyway. I would learn more there than in front of my books at any rate.
Where we are usually 12 students at the least (and often more), we were only seven volunteers today. One dietetics student, two students for screening and four for consultations. Which means that I got to do consultations on my own. I was extremely nervous as I have never really done a full consultation on my own. Fortunately the more senior students briefed me very well during the drive and so I felt a bit more at ease by the time we arrived.
Most of my patients were adults with musculoskeletal complaints, or children.
A lot of the patients we saw (the other consulting students as well) had mechanical complaints and it turns out that they were all either workers at fruit orchards or cleaners. And they were short and a bit on the weighty side. Which, if you think logistically, does explain how their occupations can contribute to their problems. Funny how even non-infectious, non-genetic complaints can cluster in specific areas.
A lot of mothers stated that they “want” antibiotics for their child’s cough – which is of course nonsense as one should try very hard to limit antibiotic exposure to little children and a cough without fever or yellow/green mucous does not warrant antibiotics. So I also got to practise explaining these matters in a good, sensitive manner to mothers.
One little girl was involved in an accident about a month ago, which got her sixteen stitches on her forehead. Since then she has secondary nocturnal enuresis, night terrors, a decreased appetite and behavioural changes. Here at least I managed to practise my psychiatry skills – and I am pretty sure she has post-traumatic stress disorder. At first it seems over the top, but if you really think about it, three year olds are not equipped to deal with the stress of accidents. So she got a referral to the psychiatrist.
I almost missed a worrying symptom in the same child. I did the history and examination correctly, but forgot to ask for her clinic card. When the sister on duty asked for it, we saw that the girl had been losing weight since November (that is, before the accident). We then tested her haemoglobin – shame, imagine pricking such a tiny finger – and it was only 8,5. So we gave her ferrous gluconate for a month, after which she needs to be reassessed.
New skill for the day: PR, otherwise known as the rectal exam. This was not one of my own patients, but a friend of mine asked if I would like to learn. The patient had symptoms of prostate pathology (urgency, hesitancy, overflow incontinence). The prostate was smooth but slightly enlarged (4cm according to the more senior student), although I couldn’t tell the size – my hands are small and these kinds of exams need practice and more practice, so at least I have started now.
I had my first run-in with Trichomonas Vaginalis infection. The patient mentioned a brownish discharge – sign #1 – and the moment she undressed the smell was distinct and obvious, sign #2. I did a PV (vaginal examination) just to be sure and referred her for a Pap smear, which is indicated based on her age and sexual activity.
I saw seven patients in five hours – which is not much as good doctor should see about 40 in a working day. Considering it was my first time seeing patients on my own I don’t think it was very bad, though. Especially since I was trying to be thorough.
My least favourite part? The musculoskeletal cases, but that is understandable: my class has not yet had our musculoskeletal block, so I know very little in the field. That, I trust, will change in the near future.
My favourite part about these clinics is that I am left without a doubt: this profession is where I belong.