last clinic + lessons learned

June 23, 2010

end of the road!
this morning marks an important occasion: i’m heading into my very last continuity clinic. almost every week for the past 3 years, i’ve spent a half-day at the duke peds primary care clinic at roxboro street, or “the rox” for short.

“the rox” is a buzzing building in north durham that houses both attending-only clinics and house-staff (resident) clinics. as residents, we see mostly medicaid patients (with the random private patient thrown in — these are typically parents who wanted a shorter waiting list and didn’t mind seeing a less-experienced physician!). it’s quite an interesting population, with a lot of ethnic diversity. we also get quite a few medically complex patients out of the duke system (NICU grads, for example).

when you start clinic as an intern, it’s scary how little you know! but for the first 6 months to a year, the attendings go into every room behind you and fill in the gaps. little by little over the remaining two years of residency, your schedule expands and the supervision lessens. this year, i’ve pretty much only had attendings see my patients when i’ve asked them to (which i do any time i have a question about anything, want another set of eyes on the patient, or get a vibe from the parents that they just need the reassurance of an ‘older’ doctor!).

i’m going to be entering fellowship next year week, which means i get to postpone being the doctor ‘in charge’ for 3 more years (whew). but if i were entering primary care, THIS WOULD BE IT — i’d be the attending! and while i still may not be a whiz with a laryngoscope and ET tube, i feel like i would be ready to practice primary care (as long as i had more senior attendings to bounce things off of on occasion, of course!).

and that — well, that’s amazing to me! i am happy to be able to say it, and mean it too. so, i thought it would be fun to share some of the pearls i have picked up along the way . . .

top 10 things i learned in the primary care clinic

10. customer service is key. if you enter the room smiling with the aim of pleasing your patient/family, things will always go better.

9. no matter what you do, 18 month olds are never going to like being at the doctor’s office. just get in and try to distract while listening to the heart/lungs before the waterworks begin.

8. good interpreters are incredibly important and worth their weight in gold (we have amazing ones at “the rox”!).

7. it’s pretty much safe to assume all 14 year olds (and up) are sexually active until proven otherwise.

6. if you have a concerned feeling about a kid when you walk in the room, you should pay attention to it.

5. it’s worth making that healthy lifestyle speech, even if it doesn’t seem like anyone is listening sometimes.

4. don’t send labs just for the hell of it or you will end up chasing borderline or questionable values. of course, test when it’s indicated, but the most things you add, the greater chance you have for a false-positive.

3. don’t mention shots until the END of the visit, particularly for those kindergarten-aged kids.

2. if you’re running late, always apologize!

1. primary care pediatrics is not easy — in fact, i think it’s one of the hardest and scariest jobs there is! you’re trying to find that sick needle in a haystack of well kids, with only minutes to do so! i have the utmost respect for seasoned primary care doctors.

and with that, i’m off to run before clinic! much to reflect on . . .



workout: 35 minutes elliptical (5 minute warm-up, 30 minutes post-strength-training), and abs/back section from the SSU week 3.

i’m still keeping track in my little st. maarten souvenir, as you can see above.

clean eating cookthrough: oh, there’s nothing like a juicy burger in the summertime! this super-simple turkey burger (just ground free-range/organic turkey + chile powder + sea salt) with cheddar and mango salsa hit the spot for me last night.

served with a veg. rainbow . . .

impressive side view!

reading: 1 hour board review (derm)


  • Reply Anonymous June 23, 2010 at 1:53 pm

    love this post! very smart words of advice 🙂 it makes me want to be a doctor right. now.

  • Reply Anonymous June 23, 2010 at 2:02 pm

    Love your lessons learned – definitely going to keep them in mind. WOuld love these for other aspects of your training/the job as well! I love how cute and organized your workout notebook is. I need to try that! Also, its time for a new agenda soon. Any reccomendations for a good 4th year-pre-crazy-mad-organizing residency applications option?

  • Reply Chelsea June 23, 2010 at 2:15 pm

    Those are great tips, and I think they can be modified to apply to a lot of professions.

  • Reply hjlongmo June 23, 2010 at 2:27 pm

    Your food always looks so delicious! I want that turkey burger. And its not even close to lunch time!

  • Reply Susan June 23, 2010 at 3:50 pm

    Ah customer service….they're not patients, they're customers! In my opinion, they're still patients, but you have to be nice to them. (And they should be nice back…people have been very rude lately!)

    Yay for the end being in sight!

  • Reply Allie (Live Laugh Eat) June 23, 2010 at 5:10 pm

    It seems like you have a 'last' of something every week! When will you finally be done already!?!

    Haha love the 'healthy lifestyle speech.'

  • Reply Jess June 23, 2010 at 6:47 pm

    Just catching up on your blog–congrats on finishing residency!

  • Reply laura jean kathleen June 24, 2010 at 12:49 am

    I'm so pleased you've written about the importance of a good interpreter. I'm a medical and court interpreter (in Spanish) and I can't tell you how many times I've interpreted for doctors who just gloss over the information instead of working with me to communicate with the patient. It's a much better experience, for everyone, when doctors value their interpreters ; ).

  • Reply Kristen June 24, 2010 at 9:00 pm

    I've worked in a primary care peds office for a few years and couldn't agree more. I never say "shots," just vaccines or immunizations if I must. 🙂

    18 month olds are always the worst it seems!!

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