March 15th, 2017 by jasongulati

I went back to work this week. Yesterday there was a change in schedule so I worked with Drs. Conrad and Scott. I genuinely enjoy seeing the difference in teaching styles and modes of practice. Where Giuseppe had me leading patient encounters, Dr. Scott did more of a top-down style where I shadowed him and he asked me questions. Less hands-on than I’ve gotten used to this year, but I still learned a lot. I observed a deep laceration repair and I&D of a boil. Had I been summoned to do so, I could have done them both solo after spending the past month rotating in the ED. But it was really better to see how they do it here. I noticed a lot more usage of peroxide for wound irrigation, whereas at home we tend to use diluted iodine or just high pressure sterile saline.

Other things I notice here:

• Patients are usually told to wait in the waiting room for lab and imaging results that the doctor will then discuss with them shortly after completion. At home, we usually say we’ll call if anything is abnormal and let them leave. I wonder if there have been issues with patient follow-up in the past that prompted this, or if there is something else at hand.
• And the relationship with nursing is very amicable, but the responsibilities delegated to them are fewer. Nurses in the US have an increasing role at home, especially those with experience in their respective units. I was talking to a German medical student who told me the relationship is far more adversarial there.
• Docs here have far less restriction in how they practice and document here. At home, everything revolves around ticking boxes for the EMR. Here, as long as it’s documented it’s fine, and because consultations are flat rate there is no drive to expand the number of systems checked on exam/review of systems. As I’ve gotten used to the rigor of heavy documentation, Giuseppe has had some laughs about the amount of detail I enter even though we did the same set of exams on a patient. I’ve also enjoyed explaining my usage of acronyms eg CTAB, RRR, EOMI etc.
• It’s also been real interesting seeing the number of “small world” encounters I’ve had with patients… I came all the way to Kampala and I’ve met people with close connections to Detroit, Lansing, AND Ann Arbor. And I saw someone wearing a Texas A&M shirt. As a graduate of the University of Missouri that normally causes a muted eye roll, but when you’re on the opposite side of the world little glimpses of home are always appreciated.

Overall, I like the workflow here. I’d definitely consider coming back here to work as an attending. I think that’s a pretty glowing review having only been here 1.5 weeks. It feels like I just got here but I’m already halfway done. It’s a strange sensation.

View from behind The Surgery, with a solid representation of the spring weather