Day 2 – Another Day in the Life of a Doctor

Work Experience Day #2 was a success; I saw even more patients than the first day and spent a large portion of time with Dr. Bloom, rather than his assistant. The following were some of today’s highlights…

• Follow-up on the 75 year old male from yesterday: Upon examining this patient’s x-rays, I was very concerned for him, as the x-ray technician explained to me that something definitely didn’t look right. Mrs. Bridges told me that the patient has Chronic Obstructive Pulmonary Disease (COPD) and that yesterday he was seen in the office for an acute exacerbation. He was prescribed prednisone, which is a steroid, as well as an antibiotic, in case he has a contagious infection.
• 9:30am patient (57 year old male): I went with Mrs. Bridges to look at his vitals and go over his medications. He was here for an office visit, specifically his annual physical. His pulse was 79bpm and the following were some of the medications he is taking: Calcium, multivitamin, fish oil, and Allegra. He explained how he has switched to only taking Calcium every other day, for he read an article revealing how calcium can destroy your kidneys.
• 9:45am patient (46 year old female): This patient had an urgent appointment, for she had poison ivy in her eye and on her hands from weeding over the weekend. She explained her situation, starting with how she was working outside on Sunday and Monday when she must have touched some poison ivy. She washed her hands after weeding, but did not think about washing her eyes, which she had been rubbing. Yesterday was when her eye first started swelling and today the symptoms were much more severe. Her eye consistently tears up, which affects her vision. She has not tried any home remedies to cure her poison ivy, but did take some Benadryl last night to help the swelling. Prednisone was prescribed for treatment.
• 10:00am patient (10 year old male): This patient was here for a “well child” check, which is simply a physical for a child between the ages of 0 and 18 years. He measured 4’7″ for his height and had a pulse of 76bpm. I then watched Mrs. Bridges administer an eye test for him. He was instructed to cover his left eye first and then his right and read whichever row of letters he could see clearly. He was able to read the 9th row out of 12 rows. He then indicated both colors on the sign test, which were green and red. His physical went smoothly; however, he does need to receive his tetanus shot (that was the only injection missing from his immunization record).
• 10:00am patient (55 year old female): This patient was at the office for her annual exam. Mrs. Bridges measured her height of 5’2″, reviewed her current medications (fish oil, multivitamin, metformin, calcium, aspirin, Tylenol as needed, and culturelle), and assessed her pain level today, which was none. The patient has had no falls recently, wishes to sleep better at night, has not been feeling down or depressed, learns best visually, and lives in a safe home. The past facts were all questions that Mrs. Bridges asked the patient. Upon Dr. Bloom’s entry into the room, he went through the patient’s family history. All of her siblings have high blood pressure and high cholesterol, which means that this patient has a genetic predisposition to those conditions. However, she exercises everyday for 1 hour and 45 minutes and eats a healthy diet, which is why she is in great health. The patient was concerned about her lab results, which were higher than normal for her cholesterol levels. Dr. Bloom eased her worries by saying they are actually looking fine and have been great the past 6 weeks. He also added that her electrolytes and blood count look great. After discussing the lab results, Dr. Bloom examined her vision with a light and then felt around her lymph nodes. He checked her breathing with a stethoscope, bent her legs to check movement, and checked her reflexes. He then asked the patient if she had any other concerns, to which she replied with a bump on her inner leg and a toe nail that had fallen off. Dr. Bloom explained that the bump on her leg was likely a little fatty tumor, that won’t go away, but has no ominous features. He advised her to check periodically for changes or pain. He then examined her toenail and explained that the nail may look deformed now, but it will grow back in another 3-5 months. All in all, Dr. Bloom was very impressed with the patient’s health.
• 11:00am patient (15 year old male): This patient had an urgent appointment, for he had lost 22 pounds within the last 3 weeks and only eats one meal per day. He was diagnosed with depression and was recommended to a therapist.
• 11:30am patient (46 year old male): This patient was in the office for a new pair of orthotics. His old pair disintegrated after 6 months. Compared to yesterday, I was able to watch the entire process of how orthotics are fit and made. Dr. Bloom positioned the man to stand on a wooden stand with rubber blocks at the bottom. He leaned the patient’s knees against a wooden bar, which had been adjusted for the patient’s height. Dr. Bloom ensured that the patient’s weight was distributed evenly between his ankles, shins, and knees, which is known as sub-taylor neutral position. The patient has heel problems so Dr. Bloom was designing soles with arches. Dr. Bloom selected flat soles that were a size 12 (the man’s shoe size) and warmed them in an oven. The patient then stepped on the soles when they were warm so they would mold to his feet. Dr. Bloom added cotton stuffing to the rubber blocks to create the arch. He then selected blanks for the soles and marked the spot to which they should be glued to. Mrs. Bridges finished the process by placing glue on the bottom of the soles and the blanks. She heated the blanks and then stuck them to the soles. Once both had cooled down, she cut off the excess blank and then used a grinder to shape them. Dr. Bloom returned to make any final touches. He then watched the patient walk and run with the orthotics to make sure they fit nicely.

  

  

  

• 1:45pm patient (45 year old female): This patient was here for a follow-up for her Urinary Tract Infection (UTI). Her medical history includes leukemia and kidney cancer, as well as the removal of her right kidney, which was why it was important her health was monitored closely. She was prescribed antibiotics for her last visit, which was when she was diagnosed with a UTI. During this visit, she took a blood test which revealed that her white blood cell count was higher than the normal range (13.8). After her antibiotics were finished, she repeated the blood test; however, her blood count was even higher, which was the reason she was in the office today. Upon Dr. Bloom’s entry into the room, she detailed her concerns. She still had pain from her UTI, was running a low-grade fever, had tenderness in her stomach and lower back, has been urinating more frequently, and began to vomit and feel nauseous last night. Dr. Bloom felt around her lower back, asking where the tender areas were, and then listened to her breathing. When she laid flat on her back, Dr. Bloom proceeded to listen to her breathing and then felt around her stomach. He explained to me that he must be more aggressive in his plan for this patient because she only has one kidney left. He ran a dip UA urine test and an abdominal x-ray. For the dip UA, Mrs. Bridges dipped a pH indicator into the patient’s urine and entered it into a machine. Within a minute, the results were printed on a tiny receipt-like piece of paper. She explained to me that a key indicator of a health condition is if the urine has leukocytes present, which this patient did not have. The urine did have slight traces of blood; however, Mrs. Bridges said that this was not concerning. Dr. Bloom returned to the patient’s room, explaining that her urine was clean and she doesn’t need antibiotics. He said that the microscopic blood hinted at a kidney stone that was blocking her urinary tract and was preventing the infection from going away. He scheduled for her to have a CT scan tomorrow, which would reveal a kidney stone. The patient’s husband was very concerned for his wife’s health, so Dr. Bloom stated that if her symptoms are severe tonight or if her leukocyte blood count is very high, then she should go to the ER; however, as of now, she is stable.

  

  

All in all, I am really enjoying my work experience so far and looking forward to the see what new types of patients I will encounter the next few days.