Today was a little different, because instead of shadowing Dr. Dupuy, I was shadowing Dr. Durand-Smith. At this particular office, doctors get one weekday off each week, and today just happened to be that day for Doctor Dupuy. Either way, I had a great time with Dr. Durand, and it was interesting to see two different techniques to the same job. Like Dr. Dupuy, Dr. Durand had a lot of well-checks or physicals, and a few abstract appointments as well. In the first minute of meeting her, she was very open and informed me about a particularly unique patient. This patient’s feet turned white, purple, and were freezing, and eventually the patient had to use a wheelchair because she was not able to walk on her feet which felt like they had needles going through them. Dr. Durand thought this was Raynaud’s disease combined with chilblains. Raynuad’s is a disease in which a part of your body feel numb and cold in response to cold temperatures or even stress. Chilblain is a medical diagnosis to describe a painful, itching swelling on the skin from poor circulation. When the patients feet were iced, they turned a bright red color and were swollen, indicators of this chilblain phenomenon. However, Dr. Durand was not hesitant to seek extra help, getting in contact with multiple duke doctors in dermatology, rheumatology, and neurology.
While this particular patient was in the back of her mind all day, Dr. Durand had a number of wellness checks for today. The first couple started in the morning, with the patients being two and under. I observed as Dr. Durand checked the babies knees, hips, back, heart, lungs, eyes, ears, nose, stomach, and privates. There were a few things that were different than Dr. Dupuy’s checkups I had seen the day before. Dr. Durand checked the patient’s knees and eyes, while Dr. Dupuy spent that time to have more in-depth conversations about food intake, nights, pooping, etc. Dr. Durand also talked about these subjects but usually when prompted by the mothers after the doctor asked “is there anything of concern today”. What I learned was that neither approach was better than one another, but unique to each doctor. What is again so interesting is that if I do decide to study medicine, you have a large canvas to decide and create whatever doctor patient experience you would like to.
In the afternoon, Dr. Durand mostly saw teenagers. Most of these appointments were also wellness checks, so I sat in her office to not make the patient uncomfortable (considering we were around the same age). While in her office she gave me a textbook to read called The Atlas of Pediatric Physical Diagnosis. With more than 500 pages, I mostly flipped through and looked at the pictures and their captions. However, there were about three to four pictures per page, so I had a lot of reading to do. It was incredibly interesting with subjects ranging from orthopedic studies to surgical observations.
After all of the teenage wellness checks ended, I accompanied her to a sick patient appointment. This patient complained of not being able to hear out of her left ear after using her q-tip to clean her ear. This would of course be concerning, but Dr. Durand already had a hypothesis of the problem – ear wax. She thought that by using the q-tip, the patient had pushed her ear wax towards her ear drum, blocking it’s ability to hear. After using a water pressurizer machine to loosen the ear wax from the back of her ear drum, Dr. Durand used a tool to pull a dark glump of ear wax greater than the size of the pea. Of course this sounds disgusting, but it was actually awesome. She preformed the same procedure on the other ear, and received a similar sized glump of dark ear wax. Other than being super cool, the patient remarked how she was able to hear better than she had in a long time.
I am so excited for my last day at the office!