PSYCHIATRY

PSYCHIATRY

“Psychiatry is a strange field because unlike any other field of medicine, you never really finish. Your greatest instrument is you, yourself, and the work of self-understanding is endless. I’m still learning.

-Irvin Yalom

                My last rotation as a clinical clerk was psychiatry. During pre-duty in psychiatry, you will duty at Cavite Center for Mental Health wherein you will interview different patients in OPD in the morning. The OPD census where usually 100 patients per day with different kind of cases like schizophrenia, mood disorders and personality disorders. In the afternoon, you will be in charge in doing rounds in the 5 wards of the hospital and assess every referrals that they have. Usual referrals were medical conditions like fever, cough and colds, scabies and other contagious diseases.

                During duty, you were in DLSUMC and you were in charge in all psychiatric admitted patients. You were also in charge of the OPD and ER for psych patients. We usually do mental status exam on admitted patients. During our duty, we had a case of a 33 years old female who drank bleach and alcohol after her break-up with her boyfriend. She was diagnosed with adjustment disorder and was subsequently admitted. We didn’t give any psychiatric medication to her but we always give her psychoeducation and coping mechanism for her condition.

                We also had only one patient in OPD, it was a case of 26 years old female who had 3 months history persecutory delusions saying that other people will come to hurt her. She was diagnosed with schizophreniform due to 3 months’ time span and presence of delusions. She was given atypical antipsychotic. Psychiatry is a good rotation and I learned a lot during our rotation especially in CCMH since you have a lot of patients. Also, you have sufficient time to study every conditions that you will encounter.

ENT

 ENT

“The ears is avenue to the heart”.            – Voltaire

This my second to the last rotation and many were saying that it was a hard rotation and a demerit prone rotation. We were 3 in the group and during my first duty, one of my group mate was going to retreat and my other group mate was absent due to his brother died.  That day, I was the only one on duty. I was scared that time because I don’t know what to do, I’m the only clerk on duty and they were expecting 4 admissions and patients in OPD and ER. It was really hard for me, since we had almost 35 patients in OPD that morning and we had 11 ER calls that night. I also went to interview all my 4 admissions and made their admitting papers and in the morning I attended their OR. That night of duty, I really cried to my friends because ‘m really tired and I have a lot of things that need to finish. I haven’t rest that night and in the morning I attended 2 OR. In the afternoon by 3pm, I still had 2 OR that need to attend. I don’t want to pass it to the next duty because it was my patient, however, Dr. De Guzman knew that I was the only duty last night and knew that I have attended 2 OR in the morning, he said to me to go home and take some rest. And that was my first day in ENT, a 30 plus hours of work.

ENT was mixed of fun and exhaustion. There are different cases in the OPD and ER that you can handle. Most of the cases were acute otitis externa, chronic otitis media, acute otitis media, BPPV, foreign body ingestion, impacted cerumen and goiters. Also, Dr. Lapitan gave me the CPG of most cases seen in ER and OPD on my first duty and she told me to study everything because I’m alone at least I have the idea on how to handle patients. Also, most of the cases on our time was decked to me, since my 2 other groupmates where in retreat. In total, I had 9 ORs in the 15 days rotation in ENT.

Also, my precept was Dr. Rivera. He asked me to do assignments regarding anatomy and he reviewed me on the anatomy of head and neck. He also taught me about management of each conditions in ENT and I witnessed how he interview his patients. It was a fun learning preceptorial since he was also telling stories about his experience as a doctor and I learned a lot on him.

In overall, I learned a lot about common ENT conditions that was usually seen in the clinic and their managements. ENT was really fun, I must be just tired on my whole duty in ENT since most of the time I was alone and there were many task to accomplished, but that’s make me more eager to learn. 

OPHTHALMOLOGY

OPHTHALMOLOGY

“Based on facts, the pupil of your eye can expand as much as 45% while looking at someone you love.”

                This was one of the rotation I enjoyed in clerkship. Most of the patient’s condition were benign and you have a lot of time to rest. In ophthalmology, most of the patients seen in the emergency room were eye redness, eye itching or eye discharges. Most of the cases I’ve seen during our duty were cases of viral or bacterial conjunctivitis. Some were foreign body conjunctivitis were we manually removed the foreign material. Some of the cases were subconjunctival hemorrhage wherein treatment were only reassurance that it will subside after 2-3 weeks.

                In the OPD, most of the cases seen were error of refraction, cataract and glaucoma. There were also cases of pinguecula and pterygium that I only see in the books before. In the operating room, majority of the cases were phacoemulsification of the cataract. We were also observed on trabeculectomy for patients with glaucoma, removal of pterygium, and avastin injection.

                During our time, we had admitted an eight year old boy due to a case of preseptal cellulitis. I thought that it was just a simple case since it was just a bacterial infection but the complications were not good as you were at risk for meningitis because our eyes were near to our brain. They were aggressive in treating the patient and was given load of IV clindamycin and gentamicin.

                In overall, I really enjoyed my rotation in ophthalmologist because I learned how to treat simple eye conditions that most of the people encounter. Also, it was a relaxing rotation since cases were only benign and easy to manage unlike in other rotations.

ORTHOPEDICS

ORTHOPEDICS
   “Bones break. Organs burst. Flesh tears. We can sew the flesh, repair the damage, and ease the pain. But when life breaks down, there’s no science, no hard of fast rules. We just have to feel our way through.”                                                                                                                                                                                                                                                             -Meredith Grey

                They said that orthopedics was fun and easy rotation, but during our time, it was not.  We rotated in orthopedic last April, it was summer time so most of the people were in their vacations. We didn’t realize that many people were playing basketballs or different sports, or sometimes they were driving motorcycle, or climbing trees or rooftop to fix something and injury just happened.

                We were toxic during our duties in orthopedics. We always have more than 20 ER calls per days compare to previous months where more than 5 ER calls were considered toxic. We have many emergency OR, emergency admission, critical patients that were referred to us due to diabetic foot. We also have so many wound care that time. Some of them were just children below 5 years old and some of them were old.

                At first, I have no idea where to find the fractures in the x-ray because even a small fracture can be seen by orthopedic surgeon. I was amazed by their knowledge in reading x-rays of bones. That when I started to search on pictures of different x-rays and comparing it to the x-rays of my patients.

                We also learned how to manage each broken bones by putting a cast or splints. We were able to assist in different operations like ORIF, wound debridement, and placement of different screws. We were also able to know pain management of each patients.

                We were also participating in their endorsements, edema rounds, service rounds and grand rounds wherein our knowledge in orthopedics and anatomy were recalled. I don’t have so many pictures in orthopedics since it was a very toxic rotation for me compare to internal medicine. I realized that I didn’t want operating room and handling bones. It was really tiring rotation. However, the residents and consultants were very kind to us and always teaching us about the things that we don’t know during our rotations.   

  

EMERGENCY MEDICINE

EMERGENCY
MEDICINE

                “And in the end, when the life went out of him and my hands could work no more, I left from that place into the night and wept – for myself, for life, for tragedy of death’s coming. Then I rose, and walking back to the suffering-house forgot again my own wound, for the sake of healing theirs.”

-          Anonymous ER Doctor

Emergency medicine was not my first choice in electives. I really want pathology but we only had limited slots that’s why I ended up in the emergency room as my second choice. We were only four in the group since majority of my groupmates don’t want emergency medicine because it is one of the toxic area in the hospital. They were asking me why I chose emergency medicine and I’m always saying that I am the first doctor in the family and I need to know a lot about handling cases as many people were looking for me. I also saying to them that I don’t care if it is toxic, or if I will not have enough sleep or eat late lunch or dinner because the more cases you will handle, the more you will familiarize on how to handle this patients.

For fifteen days, our rotations was only 12 hours duty, we were preduty from 7am to 5pm, duty from 7pm to 7am and post duty was always as relieved. Also, every day, we have TIntinnali’s hour which discusses the approach to different cases seen in the emergency room. We were taught about basic life support and advance cardiac life support. We also joined the megacode team which you will act in the scenario that they will give. We also taught on ECG reading, ABG reading, animal bite, how to read x-rays and CT scans, approach to pediatric and OB-gyne trauma, approach to patients with head and spinal cord injury and many other lectures. We also experienced to join their journal club where in one of the residents discusses about a journal regarding the help of tranexamic acid in head injury patients.
        

 Aside from so many lectures, I was exposed to different skills in emergency room. This further enhances my skills in inserting IVF, NGT and urinary catheter. I had unlimited trial of ECG placement and at the same time read the results properly. My history taking skills was also improved as I need to get the vital information as more rapid as possible. We had a lot of code blue, a lot of trauma patients and this help me not to be scared and hide at the back of your resident but to step front and have the initiative to handle the patients. They also want us to be independent and to manage easy cases on our own. They also allow us to join medical missions wherein we handled different patients ranging from children to elderly. In overall, I really enjoyed my rotation in emergency medicine. I learned a lot of things that I can use in my future practice.

FAMILY AND COMMUNITY MEDICINE

FAMILY AND COMMUNITY MEDICINE

               

                “The aim of medicine is to prevent disease and to prolong life, the ideal of medicine is to eliminate the need of a physician”.                                                      - William James Mayo

                They say that community medicine is one of the easiest rotation in clerkship since you will be in the community for almost 3 weeks and will have rest. I might say they were right. During our first day in community medicine, they orient us about the rules and regulations of the department. In our 6 weeks rotation, we will have 1 week of lectures, 3 weeks of community immersion, 1 week OPD rotation and 1 week TB dots rotation. My group were assigned to Brgy. Pantihan 4, the largest community handled by La Salle. During our first week, we were given lectures regarding vital registration, hypertension, diabetes mellitus, pneumonia, IMCI, animal bites and other common community disease that we may possible encounter in the community or in the hospital. We also had courtesy call in our designated community and saw the houses that was assigned to us. I am assigned to Nanay Puring’s house with four of my groupmates.

                During our second week of rotation, the whole group went to each community assignment. Since we were new in the place, we toured ourselves in the community and had courtesy call with the barangay officials and to our foster parents. Our barangay was composed of 12 catchments or puroks. We were far from the houses of other groups and our house was in the middle of a farm. It is about 15 to 20 minutes’ walk before we can reach the house of our other roommates. Our foster parent was living in the neighborhood and we were the only one occupying the house. During the first week, we performed the tasks that was not finished by the previous rotators. We finished reporting to the 4 catchments that they didn’t finished. We also started to make our paper in the community. However, most of the time were allotted to talking, cooking, eating and sleeping.

                During our third week, we were assigned to TB Dots department of the hospital. I thought that it was just a small place beneath Angelo King building but when I entered inside the facility, it was big inside. During our 1 week rotation in TB dots, we were assigned to different areas. The TB positive patients, the TB negative patients and TB screening area. During first day, I was assigned to TB screening area where we were performing mantoux test to patients. After rotating in TB screening area, we were assigned to TB positive patients. In here, we were interviewing patients for geneXpert exam wherein they were cases of relapse, treatment after failure and TB recurrence. Also, we were giving health educations on each patients on how to prevent transmission of tuberculosis and the importance of daily treatment. We were also performing intramuscular injections of kanamycin, capreomycin or streptomycin to the patients. In TB negative patients, we were administering a directly observed treatment on each patients wherein we were giving them the drugs that they will take in from of us. Some of them vomit, and in some of them you will see the side effects of each medications. You will see the hardships that they experience to fight tuberculosis. During the afternoon, we have lectures on tuberculosis, it causes, transmission, symptoms, management, and prevention.

                During our fourth week, we returned back to the community. There was 8 patients who were enrolled in our community program and we need to visit them twice a week to monitor their conditions. Most of them were cases of hypertension and stroke. Since we are far from their houses, we usually allot 1 hour of walk to visit them. Most of the days in the community were allotted in visiting the patient and finishing our outputs.

                During our fifth week, we were assigned in OPD. Family medicine where the first line of doctor who check the patients before referring to other department. Most of the cases we handled were hypertension, diabetes mellitus, asthma and pneumonia. It was fun to rotate in the OPD department as the residents were treating the patient holistically and not only giving medications.  They were health educating the patient about the disease. On our last week we were not immersed to the community due to NPA threats. We just finished our reports, outputs and written exams.

OB-GYNE

OB-Gyne

               

“ A baby is something you carry inside you for nine months, in your arms for three years , and in your heat until the day you die. “                                                                                                    -Mary Mason

My fourth rotation as a clinical clerk was OB-Gyne. They said that it was one of the toxic rotation during clerkship.  It was different compare to other rotation because in OB, you will be in charge of the patient from emergency room until the patient ad mitted. It was a hard rotation since you need to know the normal pregnancy, different complications of pregnancy, and different gynecologic problems.

At first, we were oriented about the whole 2 weeks of rotation in OB-Gyne. A bioethical topic was also discussed to us about terminating an uncomplicated ectopic pregnancy. After the orientation, the whole batch went to GEAMH for a tour and orientation. We will have a 2 weeks rotation on the said hospital. On our duty, we were in charge of all OB-Gyne cases that was admitted in the hospital.  Since it is the month of December, there were only few patients who were giving birth at this time. We were very benign and we only have 3-5 admissions per day. Also, we don’t have so much endorsement with the consultant since they were on vacation. The cases that I handled were abnormal uterine bleeding secondary to uterine polyps or myoma, high-risk pregnancies, and ovarian cancers.

During preduty, we were in charge of the OPD department. We were handling non-high risk pregnancies, high risk pregnancies and gynecologic cases during Fridays. Also during pre-duty, you will have a chance to rotate in OB ultrasound and OB pathology department. There were a lot of learning since the things that you only read in the books were experiencing and seeing actual.

The most favorite rotation that I had was when I was in GEAMH. We were like a real doctors since we are the one who delivered babies unassisted. We were also able to do perineal suturing alone. That time, I realized the things that we don’t experience in UMC were being done in GEAMH. I also saw the difference between private and public hospitals.