Upon my arrival at 8:30am, I was greeted by Mrs. Megan Bridges, Dr. Bloom’s assistant who I will be paired with for the next two weeks. We sat down in an empty patient room to discuss the logistics of the workplace. She showed me the “in basket,” which is a portal she uses to help schedule appointments with patients through a messaging system. Mrs. Bridges then gave me a tour of the clinic, where I was introduced to various doctors and assistants and also examined the most important rooms, such as where orthotics are made and the x-ray room. She then led me to her desk, where a seat had been added for me to accompany her. Mrs. Bridges showed me Dr. Bloom’s schedule, which consisted of 26 patients throughout the day, either every 15 minutes or every 30 minutes. I also signed a Duke Confidentiality agreement, which ensures that I will not reveal any patient information. From there, the day officially began.
Over the course of the 7-hour day, Mrs. Bridges entertained me with a variety of random facts, including the following…
- Dr. Bloom sees about 25-27 patients each day
- The morning sessions usually consist of labs and physicals, while the afternoon session are the more specified appointments
- Each doctor has a pod of 3 rooms that rotate out throughout the day
- This week has about 5,000 patients in total visiting
- June is one of the slowest months for appointments
- She received her Masters in Athletic Training
- There is a high demand for athletic trainers at the office
- Dr. Bloom is fluent in Spanish, which helps ease the language barrier, for he sees lots of Hispanic patients
- For any skin checks, she has to be present in the room to “chaperone” because Dr. Bloom is a male doctor
- Dr. Bloom has a template for all of his doctor’s notes that consist of 4 main categories: Subjective, Objective, Assessment, Plan (SOAP)
- An appointment that is classified as URGENT/ACUTE is one that is a same-day appointment
- An OFFICE VISIT is a follow-up appointment, a med management appointment, an appointment scheduled in advance, etc.
My favorite parts throughout the day were the specific appointments that I was able to sit in on. These include the following…
- 9:00am patient: I watched Mrs. Bridges administer a tetanus and pneumonia shot. After cleaning the area of injection with an alcohol pad and squeezing the skin of the arm, she quickly injected both needles and then covered them with a small band aid.
- 10:00am patient (72 year old female for a physical): I watched Mrs. Bridges check her vitals and review her medications. Her blood pressure was 112 over 62 and her pulse was 70bpm. Mrs. Bridges then went over her medications, which consisted of Zyrtec, astepro nasal spray, Flonase, metformin, Citrucel, multivitamin, and more. The patient needed a refill of her Valtrex, which she takes to heal the blisters that form on her hands after the cancer she had.
- 11:15am patient (29 year old male): I watched Ms. Grace, another one of Dr. Bloom’s assistant administer an EKG. The patient was there due to fatigue and chest pain, which was why he was getting his heart monitored. There were multiple stickers placed on the body, which corresponded with a diagram on the EKG machine. There were then wires hooked up to each stick that connected to the machine. Ms. Grace then hit “record” and printed out the patient’s heart monitor; his heart rate was 62bpm. Dr. Bloom diagnosed his condition as an unclear etiology, meaning that he is unsure of the diagnosis and will be running more tests to figure it out.
- 2:00pm patient (55 year old male): I watched Ms. Grace prepare a cortisone injection in the ratio of 6:1 for the substances mixed (clear and then cloudy). She used a large needle to gather the substances into one tube and then switched to a smaller needle when injecting the patient. The cortisone shot was administered for a joint in the patient’s right shoulder that was in a lot of pain. The patient also received some shoulder exercises.
- 2:15pm patient (13 year old male): I examined the x-rays of the patient, whose appointment was a follow-up on the fracture of his right humorous 3 weeks ago. During the x-ray, the specialist only scanned his right (injured) shoulder, for both shoulders were too broad to fit in the frame. Dr. Bloom then assigned him physical therapy exercises to ease back into any overhead activity.
- 3:00pm patient (75 year old male): I examined the x-rays of the patient, who had scheduled an urgent appointment to discuss his shortness of breath. During the x-ray, the patient leaned his chest against the plate and held his breath during the scan. Dr. Bloom’s verdict regarding his diagnosis is TBD.
- 3:15pm patient (46 year old female): I watched Mrs. Bridges create the patient’s orthotics due to bilateral foot pain. Dr. Bloom led the patient to the orthotics room, where flat soles were heated in order to mold to the patient’s feet when she stepped on them. Mrs. Bridges then placed glue on the bottom of the sole and on blanks. The blanks were heated and then stuck to the soles. The soles cooled off so it would be easier to cut off the excess blank and grind it for shaping. Once the grinding took place, Megan explained how Dr. Bloom will return to finish the soles based on the patient’s needs (ex. grind more off in a certain area). After finishing her soles, Dr. Bloom watched the patient walk and run with the inserts to see how they felt.
The blue part is the blank that was added to the sole. You can see that it was shaved along the sides and ends. 
This is what the orthotic looked like once Mrs. Bridges was finished with it. 
This is the grinder that was used to shave off the extra blank from the sole.
All in all, today was a great introduction as to what my work experience will look like the next two weeks! I am excited to examine various patients each day and continue to learn what an average day is like in Dr. Bloom’s workplace.