Outpatient

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With the conclusion of my rotation in the Ambulatory Care Unit, I have pondered on three significant issues as far as I am concerned: 1) the simulation of the community setting, 2) the omnipresent mosquitoes and 3) a student doctor’s thinking process.

Two residents taught me that the management of patients in the AMBU tries to simulate the setting in the community. It reminded me of what community doctors ought to do in their practice – keeping a minimal number of laboratory requests that will significantly help in the diagnosis and management of the patient. I find it proper because for one, doctors are stewards of the patient’s financial resource and also, the communities especially those in the rural or far-flung areas have minimal laboratory tests available. I have initially thought that the patients being seen in the AMBU are not being managed fairly because of this idea. For example, for a leptospirosis suspect, why would you order a CBC and creatinine only, and not include serum bilirubin, electrolytes and leptomat when these would yield valuable information as well? Nevertheless, it is when the physician’s clinical decision-making plays an important role to weigh which is the most appropriate step.

Dengue fever is said to be a year-round disease. And mosquitoes are omnipresent in the Philippine General Hospital. If I were to write a Critical Incidence Report, I would write about my archenemy. They are present in the AMBU, in the callroom, in the wards, and of course, in the neglected gardens of the hospital. Considering the cases of dengue fever in the hospital, even if we advise our patients to use mosquito nets, it is still unacceptable to have them in our midst.

Technically, I am not yet a doctor. I am a medical clerk, and being called “doctor” by a patient or a resident doctor has brought me both joy and frustration. I am always glad when I am called a doctor because it reminds me that I am indeed already close to that goal despite the remaining one-and-a-half year to study and train. But the same label has caused me frustration. It is indeed hard to alertly diagnose a patient. Sometimes, you know that you have read it but you suddenly forget the dose, the pathognomonic signs and symptoms, or the essential labs to be requested when you are already in front of the patient. Sometimes, you know that you are certain with the diagnosis but there is some outlying symptom that is hard to associate with your diagnosis. Or sometimes, you just feel lost in doing a procedure. In these instances, I prefer to be called a medical student/clerk rather than a “doctor.”

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