Wednesday, October 7, 2009

Moving right along

So...I got my first official pelvic exam under my belt -- so to speak. Our "guiding" patient was very knowledgeable about her body and the exam. She was really helpful in finding her cervix, ovaries, etc. I didn't do anything stupid like drop the spec on the floor, or cause her any discomfort. I found her cervix on the first try --- it just "popped" into view. I also palpated her cervix, uterus, and both ovaries. So I'd deem it an overall success. Also helpful, the model closely resembled a good friend of mine from college. Most challenging was not the exam itself but rather the language used throughout the exam. Our model recommended using direct, clear language but to avoid things such as "good," "wonderful," or "great." We needed to focus on "healthy" and "normal." Also interesting was feeling a non-pg cervix...very different from all of my prior cervix-feeling experiences.

In other news, I began my first clinical rotation at a very busy OBGYN office about 30 mi from my house. The practice is large with 9 CNMs, 9 MDs, and 4 WHNPs. They have several offices. I worked with one of (two) male midwives in the area. My preceptor has been a midwife longer than I've been on this planet. The office was fast-paced and we saw 17 patients in a "not so busy" day. Also, this first day was supposed to be mostly observation, but that didn't last long. Within the first twenty minutes, I was checking cervices, doing bimanual exams, measuring fundal height, listening to FHTs, and doing a majority of the physical assessment. Most interesting case of the day....a pt who comes in with 2 +HPTs and an IUD. In our office, she had a +pg test so we pulled the IUD. Turns out she had a ruptured bleeding ectopic on the right side. We sent her to the hospital for surgery. Kind of a big deal for my first day. I saw pts from age 16-61. And I worked with both midwives in the office. I'm going to be doing two days a week in the office for the rest of the semester. Seeing pg pts is my most-favorite, especially when they're full of baby. I just love laying hands on pregnant bellies and talking to the mommas. Just reinforces my love for what I will soon be doing. I found myself working with newly pg pts, calculating their EDC, then wondering...maybe I'll catch your baby.

And on another note, I think ICD9 & CPT codes are horrible. We have to track all of our patient encounters in a database for school. We have to add every patient we see as well as use the appropriate ICD9 and CPT codes. This is quite overwhelming...I've only been able to enter 6 of my 17 patients from this week. Ridiculousness continues....please explain to me why there's an ICD9 code for a Bartholin gland cyst and abscess but not a code for Skene gland cyst or abscess...? (Had a pt with one of those too.) I'm sure the coding will get a lot easier as I go along, but for right now with all of the other work I'm's way too much.

School is going alright --- I'm finding that a lot of information we're getting is repeated from my undergrad, since I am a segue student. In particular, my Advanced Pathophysiology class is almost verbatim from my other pathophysiology class. It's sort of annoying but also convenient because I saved all of my notes & study note cards (via iFlash). So I think I've got an advantage. My research class is terrible...full of time-consuming unimportant busy work. I will be happy to have this semester over.

Up for today...male genitourinary exam with a DRE on a "guiding" patient. This is going to be horribly traumatic as I will never take care of adult males, ever! Some of the other midwifery students did the exam last week and said it was terrible. *sigh* I see some alcohol in my near future.

I'm heading out tomorrow to go to VA for fall break. I'm super excited to see the family for a few days. I know I'll spend some of my time reading & studying because we have a midwifery exam on the day we come back.

On a side note, this week was Midwifery Appreciation Week :) We're having a celebratory ACNM chapter meeting next Tuesday. I'm really enjoying getting involved with the local chapter and going to meetings. The midwives in the area are a really closely-knit circle. A lot of our preceptors, we've met at the chapter meetings. I've got a lot more to share, but this is a good start.