So there’s a white coat hanging in my closet . . . now what could I do with that?
Let the clinical exposure begin! (ok, shadowing doesn’t necessitate a white coat, but it’s a good segue)
My first step into the patient room (from the other side that is) took place at UTSW’s Monday Clinic. Each Monday, teams of MS1s, MS2s and an MS3 or 4 team up to interview, examine and diagnose patients at a North Dallas Shared Ministries clinic. Finally, my chance to see a REAL patient! They say you never forget your first patient, and while this wasn’t actually my personal patient, Mr. Valdez will always be at the back of my mind (especially now that he’s codified here). The MS2 led the history and we conducted physical exam under the guidance of our fourth year; looking into Mr. Valdez’s eyes, ears, mouth and nose and listening to the beat of his heart and lungs, we identified crackles from the air’s fight to escape his infiltrated lungs. What we first presumed as acute rhinitis quickly transformed into a potential case of bronchitis or pneumonia. After the attending eliminated our constructed differential diagnoses, we prescribed Mr. Valdez some (free) medicine and sent him on his way. For our second patient, it was my turn to interview. Uh oh.
Thanks to the kind guidance of our MS4, the history of Mrs. Sandez’s urinary tract infection flowed along smoothly. During the H & P, we addressed the tell-tale signs of UTIs and ruled out kindey disease to sufficiently diagnose the malady. Our only bump, a negative UA (urinary analysis), was easily explained after a bit of investigation. It turned out that when Mrs. Sandez encountered symptoms of her UTI, she obtained some medicine just as she did last time (which happened to come from a Mexican drug supply source here in Dallas!). Nonetheless, this time the medicine didn’t work as well and she stopped the dosage prematurely. After the story pieced together, we prescribed some ciprofloxacin and Mrs. Sandez was on her return to good health.
At the Monday clinic, I had a seemingly obvious revelation. The history, not some simple diagnostic tool, is instead a diagnostic pathway or map. With the tools to correctly navigate the convoluted path of human pathogenesis and its manifestations, a cure is possible and with the correct training, it becomes probable. By 2012, it will be UTSW’s job to divulge such abilities, the pathogen’s job to present such opportunities and my job to take advantage of it all. (Is it me or are most of these endings turning out to be more like little personal pep talks?)
Until next time . . . the ER!





Medicine is the place for me
