On my first elective- feeling dumb, histories, and gifts

[Guest windymountain2003]

I 've been doing my first elective for three weeks and have one week left. My elective is in family medicine and I have two years of medical school left.

 

I have a few concerns that I would like to bring up.

 

1. I feel pretty dumb right now because I am constantly being asked questions by the doctors I work with. I find that I am asked what drugs for what bugs and what bugs cause what problems etc. I usually try to answer, but draw a blank and feel pretty dumb. I want to know how much other students remember on electives before clerkship and when/how they remember things in the long-term.

 

2. I have been asked to do a lot of detailed histories at yearly physicals in the clinic. When I ask older people anything about sexuality as I have learned to do, I find that they look annoyed/stop wanting to talk to me. I am tempted to stop asking this to people over a certain age to avoid losing patients but would this really be appropriate?

 

3. I would like to give a gift to my preceptor as she is not being compensated as far as I know. What would be appropriate? I was thinking a toy diagnostic kit for her office (as she has a lot of kids in for vaccines/check ups). I would also like to get something more specifically for her.

 

Thanks,

 

WM

[Guest FrancophoneRN]

I can answer no. 2 for you.

 

Ask questions on a need to know basis, instead of nice to know. I'm sure you know this already. For a full physical with an elderly person, sexuality is definitely a nice-to-know question unless their complaint may warrant questioning into the sex stuff.

 

I found out in first year of nursing that you do not have to go into all the details with the patient, no matter what they tell you. And if you have to, you can do it tactfully and delicately with an elderly person (or anybody that you think will feel uncomfortable with your upcoming line of questioning) simply by warning them of what you will ask them and that you understand that this may be a bit uncomfortable to talk about but you need to know for X reason... Eg: Now, the next question I have to ask you will be a on a pretty personal topic, but we need to know this in order to better treat you. Everything will be completely confidential and we're only asking you this because we need to. Have you ever been treated for syphilis ? How many sexual partners have you had in the past year ?

 

Also, explaining the reason why you need to know will encourage them to answer truthfully, enhance cooperation, and reduce (ever so slightly) indignation.

 

And as long as you respect the cultural/age conventions (eg. eye contact, words used, the gender of the person asking, space between persons, etc), the experience will be easier for the patient. And if you will go into the really intimate stuff, make sure that they are not with their partners or families. They may say it's okay, but tell them that you will tell them the subject in private before they can consent to have the others present, otherwise you'll compromise honesty and embarass them more.

 

And I also find that if you have an attitude and demeanor that you are comfortable with talking about the subject, they will be too. And it's definitly not the first thing you'll launch into, you have to oil them up first. And reconcile yourself with the fact that some will clam up and be pissed off no matter what you do.

 

So keep it on a need-to-know basis, check with your mentor to make sure (do I really have to go into sexual health history ? why?), and you will do fine.

 

And you'll be surprised what people will talk about with you. Most people, I find, are okay with talking about embarrassing stuff as long as they know it will help them and they trust you.

[Guest FrancophoneRN]

The gift you're intending to buy sounds fine.

 

As for something for her, a nice tin of amaretto cookies are always nice since it's tasty, she can share, and the tin is beautiful and can be used elsewhere.

 

I'm sure you're noticed her hobbies or whatever if you've talked to her or listened in on some conversations. If she likes to cook, get her a nice bottle of olive oil or vinegar. A frame is always nice, and affordable. Body Shop stuff is always appreciated, like a pedicure kit. Anything they can pamper themselves with, if they're so inclined. Buying him or her lunch is nice. A bag of quality coffee or tea is always appreciated as well. A plant, if they like plants. Or a nice coffeetable book with lots of pictures on whatever subject or hobby they enjoy. Don't go over 20$ for gifts though, otherwise you're weird.

 

And I always reccommend you get something for the staff at the office you work at (nursing and administrative team) so that you can make a good name for yourself. Get a quality box of chocolates (something better than pot o'gold, or anything you'll find at Shopper's). That's where Godiva, Laura Secord will be truly appreciated and remembered. That tin of amaretto cookies or specialty italian cookies are appreciated. Or a good plate of baklava. Make friends with the auxiliary staff, and you have allies. And I wouldn't wait for the end of your clinical to get them a gift. You should give them something mid-way your clinical, and at the end. And you clinical will go waaaaaaaaaaaaaaaaaaaaay easier.

[Guest Lactic Folly]

Great posts FrancophoneRN.. those were a lot of nice gift ideas. Any thoughts for a summer research student? In the past, I've gifted the admin at the end of the summer, and the supervisor (with whom I have more continued contact) at Xmas, but maybe it's better to gift them all at the same time?

[Guest FrancophoneRN]

Gift twice for admin staff since they don't have to make your stay a pleasant one. Make the gifting slightly personal (with a card or private word) since they will see the sincerity and good will. And gift even if they made the effort of making your life difficult since they you pave the way for others and you want SOME good thing to be said about you (eg. She was a complete tool, but I guess she's not that bad... she knows we deserve Godiva chocolates!)

 

As for the preceptor. Gift once since they have to be nice to you. But gift more expensive and personal since they made a special investment on your part.

 

That just how I see it and how I've practiced in the past as a student.

[Guest lex]

A sexual history on an elderly woman may in fact be a very important thing to know. In general, you can be sure that most elderly women won't feel inclined to bring up sexual problems/questions; however, if approached appropriately, there's much to be benefited. Sexual medicine has gained a lot of momentum in recent years and taboo's are being broken down. In my humble opinion, a sexual history is, at the appropriate time, a need to know thing.

 

At UBC, we had an entire block on sexual medicine. It was also weaved into our clinical skills program (we spent three sessions learning to take sexual histories from men, women and couples).

 

In the family practice clinic I was assigned to, my preceptor and I took numerous sexual histories and in doing so, we uncovered many sexual health issues that would have otherwise remained uncared for. It was quite surprising in fact.

[Guest moo]

As for your first question, relax, it's entirely NORMAL! In time, you will start seeing things over and over again, and things will become very routine. When I first started seeing patients in first/second year, all I could go by was the trust OLD CARTS pneumonic. As you get more experience you start developing a differential even before you see the patient and start tailoring your questions to try to reach your diagnosis. Pimping is a regular part of the game; you're not going to know a lot at this stage so just smile and guess or say you don't know. Most important is to look confident.

[Guest McMastergirl]

I couldn't agree more with moo. I'm just starting my second year of residency, and I've noticed over the past few months that (a) I'm getting asked fewer questions and ( I know more! This may seem obvious, but it's a great feeling to be the resident, finally, and see the med students getting pimped, and knowing that I wasn't the only one who felt like that! It does take a while to get used to not knowing things... my advice would be, if you don't know, just say "I don't know"... better to appear ignorant than to open your mouth and remove all doubt! However, if you think you know part of the answer, tell them what you do know, and what you don't. It's part of self-appraisal, knowing what you DON'T know. And ask questions too... especially the small ones. The bigger questions you can look up on your own.

You're doing fine!

[Guest NurseNathalie]

Well said, FrancophoneRN

 

Depending on the case, of course, I think that we SHOULD ask those sexuality questions... I didn't realize how many of our elderly had questions and/or problems with sexuality until I showed that I was willing to discuss it... especially with post-menopausal women! if anything, it demonstrates that we are open to discussing their issues. You don't have to go into great depths if they say its not an issue.. but aboarding the subject gives you a pretty good idea of whether or not they have concerns in that area... no matter how old they are perceived to be.. sexuality is a big part of life.

 

just my experience anyways ...