Hold On and Don't Let Go!

Some background stuff first: In my program we learn by body systems. For example, our first module was Head, Ears, Eyes, Nose and Throat (or HEENT), so all the diseases states, tests to run, labs to ask for, history questions to ask and physical exam skills, and anatomy lab/lecture all pertain to those portions of the body. At the end of the 'module' we take an exam that has all of our classes on it. (Well most of them at least) Which is anywhere from 110 to ~300 mulitple choice or T/F questions.

With that being said, PA School whips by like a flash of lightening!! I am finding it hard to believe that we are already about 2 wks into this module (Pulmonology) and we have 2 wks to the day to become "experts" enough to pass the module exam (more on passing later) .... At the current moment I feel completely lost, and frankly a little burnt out. I think one of the most difficult things for me is sorting out the different diseases. Sometimes the differences between one disease state and the next is simply the fact that one has a cough without mucous being coughed up (sputum production) and the other just has a cough without anything being coughed up. The problem is that things in medicine are rarely black and white, and the patients I will see will rarely, if ever, be textbook examples of a disease. Which basically means that symptoms will often blend in with other disease and often you have to use all that you have been taught to make the best possible diagnoses you can. (Or rather pick the correct diagnoses on the exam ... let's see is it A or B?)

Bottom-line: to all of you Pre-PAs, and PA-S that are maybe just starting out as well, start thinking clinically as soon as you can. Do your best to get out of the mode of just memorizing facts like you had/have in undergrad and start thinking more 'whole-picture'. Sometimes simply picking up the patients occupation in your history taking can make you pick one diagnoses over the other (which goes back to the "whole picture" approach). There is just not enough hours in the day or days in the week to read and swallow every bit of every class, so consolidate the best you can to make the most of your time. In the group I study with we will have one person pick a disease state, go up to the white board and make a 'fake' patient and we go through creating a differential diagnoses (possible diseases that present with the chief concern (ex.. "I have a cough that has lasted for 2 wks now."), asking questions that we would ask, perform PE exams like we would do (and what we are looking for in each), get labs/tests that we would run (and what we would expect them to come back as, or what we are looking for to rule-out a certain disease), commit to a diagnoses then how we would treat that and whether or not we would follow up, etc... In doing this we bascially hit Pharmacology, PE Lab/Lecture, Primary Care Medicine, Pathophysiology, History and Physical Exam, even some Anatomy in there.

Since I started writing this blog entry a couple of days ago and am now finishing it up, I can not recall what my point was in this one, so hopefully it made sense. I think I was just trying to give you a sense of how intense this program has been so far. Way more so than I had every imagined for sure. OK, well I have to get back to Acute Epiglottitis and the Pneumonias. Hope you guys are enjoying so far. If you have any questions go ahead and leave a comment and I will do my best to answer, them as I blog.

M-R