Archive for tag: patients

Comprehensive Exams

Only four more weeks to go and I can barely believe it! 

With graduation, comes what seems like never-ending tests. I have previously spoken of comprehensive exams that must be taken as an intern increases in clinic rank. Well, the Exit Exam is similar but only for those that are graduating. The exam's purpose, I have heard, is to make sure the graduates are fully competent and will be able to pass the boards tests.

The comprehensive test is an accumulation of questions from various instructors of the program. They often are old test questions so they should be familiar to the student. The exam includes sections of Biomed, Foundations, Points, Differential Diagnosis, and Herbs for those in the herbal program. The comp test usually includes a practical portion, but this portion is excluded for those taking the Exit Exam. After taking the Biomed Board and currently studying for the Herbal Board, I am not worried about taking this exam; it should be a piece of cake. The comp exam does require a pass rate of 70% to continue in the clinical portion of the program. The instructors have chosen the 11th week to take the exam so there is sufficient time to make up the exam for those who need to retake it. The same applies for graduates taking the Exit Exam.

Projects

Photo of Dr. CaiAnother project I am working on is a uterine fibroid case study for my Herbal Senior Seminar with Dr. Cai. This class specifically focuses on OB/Gyn topics. This is very important since at least 70% of our patients are females who may have some gynecological complaint. Infertility, painful periods, no period, or menopausal disorders are often seen. I have not had a patient with uterine fibroids so this is a great opportunity to research the topic. 

I will obtain a complete medical history from the patient and then come up with a treatment plan and herbal formula for the particular patient. On the day of class, I will bring the patient in and we will have a grand round-like atmosphere. I will share the case with the classmates and Dr. Cai. Then there is opportunity for any other questions to be asked directly to the patient. After, we will provide treatment to the patient. This type of class format is great because instead of paper cases we can actually talk to the patient, take pulse, and look at their tongue and observe their constitution. Whatever your learning style, I think one will find that the program accommodates all of them.

Making Herbs

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I have probably already shared that Dr. Cai is my favorite professor and clinician, so having a class taught by her is refreshing. I am currently taking Herbal Treatment Strategies with Dr. Cai. The class is small with only five students but it is nice because everyone is able to ask questions or speak up if so desired. I like the fact that we can choose what we would like to learn. The topic each week is determined by the student. Dr. Cai requires each student to give two presentations based on cases of our patients, so in fact it is similar to grand rounds. We present our patient and patient's case to the class.

So for instance, last week was my turn to present a case to the class. My patient's chief complaint is hepatitis B. I prepared a presentation for the class that included the patient's medical history of the chief complaint, TCM 10 questions (for those of you not familiar, 10 questions is one of our diagnostic methods, and we also look at the patient's tongue and feel their radial pulse), TCM diagnosis, treatment strategy, point prescription, and herbal formula.

After presenting my case to the class, any other questions from classmates are directed to the patient. Everyone will look at my patient's tongue and take pulse. Then everyone states what they feel the diagnosis is. (It's kind of like the TV show House because every idea is written on the white board.)  After narrowing down to the correct diagnosis, a formula is selected based on the patient's condition and TCM diagnosis.

Finally, the formula is modified based on the patient's constitution. Herbs may added or removed and dosages modified. The whole three hours is a true learning experience. Each class may be different from trimester to trimester because each student chooses the topic/illness for that week. So far we have discussed herpes, psoriasis, hypertension, abdominal pain, insomnia, ADHD, IBS, and hepatitis, and we still have five more weeks to learn even more. After lecture the patient is needled for free as a token for their time.

I hope I didn't confuse you, and if I did, shoot me an email, I'd be glad to clarify any questions.

Herbal Formulas

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Hey there! It seems like there is a family event almost every week in the summer, which sure makes it difficult to study. I must plan my study time accordingly.

First, it was my brother's birthday and the next day I spent the morning with my husband in Chicago. He had an Active Technique Release Seminar and Sunday was his last day in which they were tested on the 104 techniques they learned in three days. He passed!! We celebrated by walking down Michigan Avenue to Oak Street Beach to have an outdoor lunch looking at the water. I haven't been to the city in a while so it was a nice treat.

Back to studying when we arrived back home. My Formulas I class midterm was emailed to me and I started working on it since it's due in a week. A take-home midterm sounds easy enough, but it sure is time consuming. Our class agreed on a take-home midterm vs. a mini multiple-choice test. We all agreed that it would benefit us more by analyzing the formulas and comparing their ingredients and actions. This test is similar to a research paper in that what you learn is utilized in a way that it is put into long-term memory. Cramming for a test only holds the information in short-term memory, which will not benefit us.

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In clinic, I have applied some of the knowledge I have learned from Formulas. I had a patient two weeks ago that usually comes in for treatment for infertility but she had a come down with the "common cold." With help from Dr. Cai, I was able to prepare a formula based on her pathology and underlying constitution.

In Formulas class we start out learning formulas that disperse wind, cold, heat, and damp, and for those with an underlying different constitution, in other words, for different types of colds, flu, bronchitis, etc. Dr. Xie, my Herbs class professor, is a great teacher. He is thorough and relates the information to cases he has had or seen in clinic. He requires us to participate and apply our knowledge of herbs and diagnosis to the herbal formulas we are learning. This is rewarding because it has helped me in clinic and refreshes my memory on things I may have forgotten.

Well, I have a busy week ahead. Wish me luck!

What a Week!

Wow, what a week it has been. Clinic seems to be crazier than ever. I blame it on the full moon after the spring solstice!

It never fails but no matter how hard you try not to be like your parents, one way or another you will take on at least one of their traits. And mine is time management. In clinic we have a time slot of one hour and 20 minutes for each patient, and double that for new patients because their intake takes longer than a re-exam. As much as I try, my intake always takes longer then I allot myself. I don't think this bothers patients unless they are in a hurry, but I do get teased by fellow classmates or clinicians.

I guess, I know how much I hate the typical question-answer intake, and like one of my professors put it, "get a narrative from the patient." I find by letting the patient talk about their week, they will answer my questions but I will also learn more than if I just asked a serious of questions. Dr. Cai knows me by now and often pops her head in to see how everything is progressing.  

But, this is a concern of mine especially when I start my own clinic with my husband. It seems like a double edge sword. A patient's comfort is important, but time management is as well because underneath there is a business to run. I haven't had business class yet, but when I do, I hope time management will be a portion of it.  

Monday I had a new patient who came in for sinus congestion and phlegm accumulation. As I was taking his intake with the chiropractic student, I learned he could not take a deep breath without coughing. After listening to his lungs, the chiropractic clinician decided the patient needed X-rays of his lungs and blood tests to rule out cancer, tuberculosis, pneumonia, or infection of any kind. This was an awesome learning experience because even though I haven't had radiology class, I am in lab diagnosis and knew what we would be looking for on a CBC (complete blood count panel). I also was able to observe the process involved in setting up and taking X-rays. It was really cool!

Needless to say I was scrambling to jumble treating him and my last patient. I still needed to fill out the 'first time patient' paperwork and make my herbal preparation and fill out my S.O.A.P notes for my second patient. After all was said and done, I didn't get out of clinic until 1:15 and my shift ended at noon. Wow, I am out of breath just writing about it.

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This weekend I did get to relax by going shopping for my upcoming Hawaii trip!! Yay!! And on Sunday, my husband and I celebrated Easter with our families at our favorite Hungarian restaurant, The Epicurean. (I am part Hungarian.) It was nice to visit with family and have a few good laughs.

Clinic

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Four tests down and still two to go just before starting finals and a pathology presentation. But enough about tests I want to talk about clinic. 

I am in clinic two days a week on Monday and Saturday mornings. The shifts are four hours each with a maximum of three maybe four patients. Monday mornings are slower than Saturdays. (It was rough getting up Monday due to the time change.)

Three to four patients may seem like a good thing, but interns have quotas we must meet before we can graduate. Some of them include: patient numbers as well as new patients, herbal formulas, cupping, tuina, and electric stimulation. New patient appointments take two slots because the first appointment is comprehensive with a complete western medical history and vitals as well as any other orthopedic tests that may be done. A chiropractic intern is involved in the history and asks any further questions that may help the diagnosis process that will also become part of the patient's file.

Last Saturday, I had a new patient as well as two others. Boy, was I busy but I loved every minute of it. My first patient came to the clinic as a referral from a massage student from another massage institution. She came to the clinic with the hope of smoking cessation. She had tried other methods, such as the nicotine patch and gum as well as hypnosis, but with little success.

Acupuncture has a great protocol for overcoming the emotional, physical and physiological attributes involved in detoxifying from an addictive substance. Auricular acupuncture is used. (The ear in Chinese medicine is thought to be a microcosm of the body, meaning the whole body is mapped out onto the ear). I also used other points on her body to help strengthen her constitution.

After the needles were removed, I inserted ear seeds (vaccaria seeds) with adhesive tape to a specific acupuncture point on the opposite ear being treated. I instructed her to use acupressure on each of the seeds for 15-30 seconds, four to five times a day or whenever she was craving a cigarette.

Upon leaving, the patient stated, "I feel great and I have no cravings for a cigarette. This is wonderful!" That statement made me feel good and just reinforced why I chose acupuncture to help people.