bought some pants today at the gap outlet. When I showed my husband he actually said the words "hallelujah no more MC hammer pants". I guess I didn't realize how baggy my work trousers were getting.

teaching

In two weeks I start teaching medical students clinical skills. I went to a meeting last week about the curriculum etc. I realized that this school does not have a clinical skills manual like we did when I was in med school and the expectations of the modules is not set out for the students. I find this very odd. The modules are based on clinical problems rather than body systems - i.e. heart failure, dehydration, kidney stone. I find this odd as many clinical problems have examination overlap. Relating the examination to a clinical problem is great, but one has to have the basics down. Pairing the renal and bladder examination (part of the abdominal exam) with the peripheral vascular exam and the "fluid status examination" of the JVP - which should be part of the cardiac exam, seems very odd to me. Hopefully I'll have my head wrapped around how to do this logically in the next week or so.

snap out of it

This week I became too cynical and the patients are starting to notice. For some reason, I walked in to appointments thinking that people were always going to ask me for something I didn't want to give them. Or that there was going to be a confrontation. Or that I wasn't going to know what to do. It made me a worse doctor. I need to consciously get back to giving people the benefit of the doubt. I think a lot of it revolves around the patient population. Lots of people with narcotic problems, lots of people who've been given narcotics by the doctor who I'm filling in for that I wouldn't have necessarily given narcotics to, lots of chronic pain that I feel helpless to treat. I think narcotics are one of the things I feel most uncomfortable about and thus I end up leaving people unsatisfied. I give people other things for pain, of course, but often what they're looking for and what I'm giving are different. Unfortunately, this makes it very difficult to have a trusting and pleasant relationship. I need to check my head next week.