FM: G clinic & denial

So I'm pleased to report that the G clinic is so much better than the N clinic. I got hooked up with a few residents (more like I figured out) who would let me talk to the patients on my own or at least conduct the interview while they were typing. This electronic medical records system is really slowing them down alot.

I feel like even the seniors are a feeling a little behind with their patients.  These residents are funny because they have such a different perspective.  They always compare how many patients they have that day and 8 per half a day is "a lot." The way it works here is everyone gets a hour and half lunch break.  Usually you spend the first half an hour finishing up your patient or your paperwork and then you get an hour lunch. I always feel a little bit of a loser going out to lunch downtown surrounded by people in suits, eating alone with a white coat and stethoscope on.  Hahah.

Lots of these residents are foreign. And i got assigned to a guy who is Arabic. One of our patients, DL, is a small Arabic woman who doesn't speak much English, comes in.  She has been diagnosed with breast cancer that is 80% curable. However, she is in such denial that she doesn't believe she has cancer. It doesn't hurt and despite the 4 biopsies she insisted on that turned out positive for cancer, she won't be convinced.  It took doctors 4 years to talk to her into chemo where she complained that she felt worse after the first treatment and since the lump did not shrink it must not be cancer.  She also was offered a surgical option and she talks in horror about losing her breast for no reason and despite reconstruction refuses.  Doctors including her primary care physician (PCP) and oncologist and surgeon all of whom speak arabic have spend over 60 minute appointments in the last 5 years trying to talk her into getting treatment since her cancer hasn't metastasized yet.  It was the one of the most frustrating patients i've seen yet. I am ashamed to say I just wrote her off after about 15 minutes into the discussion. We can't make her do it, all we can do is explain it and offer options.

There was another case I saw that same day that I again wrote off in the first probably 10 minutes. She was a 19y.o. female but she just kept changing her story. She came in for vaginal pain, but every time we asked her questions about her symptoms or history she changed her story.  Her first time having sex was last year then at 14 then at 16. She said she only had 2 partners then 4 then over 20.  She then didn't have discharge then did then didn't but it was a smell.  Basically, we ended up not even knowing how to present the patient to the attending doc. And we did a full panel for all STDs, UTIs, and yeast panel. We also did a pregnancy test, which was negative.  But these cases are very hard-- and i am only a third year.  And I already wrote her off within 10 minutes.  I feel a little ashamed, but I don't really know what else to do about it.