Wednesday, April 1, 2015

Three Months' Review and One Month's Expectation

It's that time again-- time to reflect on the month that has gone by and see how well I met my goals, and to look ahead to the next month. But first, I want to briefly review January and February again, because there are some things I'm still learning about my areas of focus during those months. As a refresher, my goals were to approximate a direct primary care practice in my clinic in January and to do a bunch of procedures and learn 21 French words a day while in Togo.

January: Clinic
The most beneficial thing about trying to make my clinic a direct primary care practice is that I am much more intentional about how my clinic operates now-- even though I have found that I do not have as much control over my schedule as I would like to have. The main issue I am coming up against is that I continue to be scheduled for 8 or 9 patients per 3.5-hour half-day when I have repeatedly made it clear to my schedulers that I only want 6 or 7 patients on my schedule. This conflict is just a foretaste of what I would be in for if I was to join a traditional-style family medicine group, and is the sure-fire path to burnout. Every clinic I have had in the past 3 weeks since I have been back from Togo, I have had at least 8 patients on my schedule, and every evening, I leave the clinic stressed, frustrated, and knowing I could have done a better job. So, even though January is long since passed, I will continue to work with my clinic staff to find a way to see less patients each half day so I can give each patient the time and attention they need and deserve.

February: Procedures and French
The main barriers to achieving my procedural goals in Togo were the needs of the hospital and patients, which I was happy to oblige. It just so happened that I visited at a time when there were a lot of surgeons and not very many doctors or PAs in clinic, so I felt like the right thing to do every day after rounds was to head over to clinic and see some of the many patients who were waiting rather than run off to the OR. Nevertheless, I got a dozen or so spinal blocks (they rarely intubate) the last few days, when there were less surgeons around and a few more medicine people to cover the clinic, and also snagged four Caesarians and a few other surgeries. On the language front, I sometimes had the head-space, willpower, and energy to apply myself to French study, but often felt led by the Spirit to take a long nap. I'm not sure how many days I hit my mark of 21 words a day, but it probably wasn't very many. A major reason for this is that I had translators in clinic who often spoke in Ewe to the patients anyway, so it was so much faster to communicate with them in English and let them communicate with the patients in whatever language they were most comfortable with. In the future, I hope to live in a home-stay with a French-speaking family, in order to be immersed in the French language rather than being exposed to it as a third-party.

March: Teach
My specific goal for this past month was to teach medical students and interns about 21 different topics. Well, I haven't been tallying every little conversation I've had with the students, but I'm confident I've not yet reached my magic number. But I've learned and grown in my teaching skills in several important ways. First, I've finally come to the point this block of medicine where my own work is smooth enough that it can sometimes take a back seat and allow me to focus on teaching. On medicine, we have four medical students at a time, and my strategy has been to send the medical students to start seeing new admissions when we get them (which is standard), but to always have the other students who aren't seeing patients working on a little presentation they will give to the group. Taking advantage of this down-time has been a big stride for me. I've typically been giving them 30-60 minutes to prepare their talks, which provides the urgency and eustress that will allow them to focus and learn efficiently. Today, I gave them the afternoon and evening to work on topics I assigned them, and promised we would go over them tomorrow. This will hopefully allow me to go over their topics briefly on my own tonight or tomorrow, although it's getting late so that might not be possible. But ideally, I will brush up on the topics enough to feel comfortable giving a mini-lecture on them myself to supplement the students' presentation, which will reinforce the material in my own mind and become part of my growing repertoire of spiels on sundry medicine topics.

April: Read 21... Journals. And Teach.
My goal for this month was originally to speed-read 21 books, but I have decided to switch that goal out with June's, which is to read 21 journals. Part of the reason for this is that I have a giant stack of journals on my bedside table that have been staring me in the face for months. I'm tired of the guilt that rises when I take note of them in their silent yet pedantic condemnation. Another reason is that I'm still on a service block this month (Pediatrics), and want to continue to focus on teaching medical students and interns. Journals are much more pertinent to teaching than most of the books I plan to read, and will help me focus on learning more about topics I can teach to my junior colleagues. I also just picked up another batch of Pediatric AudioDigest cd's, which are medical lectures I like to listen to in the car. 

Perhaps this month, I'll be able to keep track of the topics I teach about, and may even surpass that magic 21. It should certainly be easy to keep track of the journals-- I'll just have a "Have Read" stack to supplement my "To Read" stack, and will count them up at the end of the month. I'm excited to refocus this month on my goals, and plan to make a more concerted effort to quantify how close I am to reaching them. Hopefully in a month, I'll have success stories to share with you all. I will at least be sharing some lessons learned.

Until then, keep growing.


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