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    Focusing on the patient while under pressure

    Working quickly without hurrying and being attentive without obsessing: Navigating the information-ridden life as a 21st century resident physician

    “Medicine is inherently a literary field as it can be taught and discussed exclusively through the telling of stories.” Mark Reid, MD

    A 36-year-old presented to my continuity clinic as a new patient. She had been followed for abnormal Paps and was scheduled for a repeat colposcopy. It had only been 6 months since her previous colpo. I opened up my American Society for Colposcopy and Cervical Pathology iPhone application and iterated her information to make sure she was not due; she was not. I would just take a look — working quickly without hurrying.

    I placed a speculum in her introitus and there it was: a 6-cm fungating mass. Each spherical tumor reflected its own callous heart lined along the void of her cervix. I was staring deep into the proliferating soul of cancer— “badness” was in my face. I had to tell this struggling single mom that I did not know exactly what this all meant but we needed to follow up.

    Medicine today is an open book. I can easily deduce diagnoses by searching descriptive keywords in my browser. Access to endless information, showers of texts, plug-in guidelines, atlases, and histology from centuries ago are all at my fingertips. I am thankful for the privilege of practicing medicine today.

    More of Dr. Afshar's blog entries

    As I started the patient’s SOAP note, the EMR fields began to auto-populate before I could transcribe via keyboard. This auto-filled template was not my patient. I wanted to grab the computer and tell it to stop, but my job was to translate to the screen that I had a sick patient who needed help. My cell phone went off, my meter was running out in front of clinic.

    The patient was seen at the free clinic, which meant she was uninsured. How would I get her to a gyn oncologist? Does providing healthcare in the 21st century mean I need to be an expert navigator of the health system? No. But it means that I need to know when to reach out for help. I spent that afternoon on hold with the MediCal eligibility officer because that is what I could do for this patient. I waited for 45 minutes—calm progress.

    The next morning at 5:30, my Twitter feed and PubMed keywords started flooding my phone. While reading a news-breaking abstract, I was receiving live tweets from a conference back east. I noticed a retweet from a Facebook posting I made and I forgot that I started reading an abstract and got distracted midway by an email about logging duty hours.


    Yalda Afshar, MD, PhD
    Dr. Afshar is a Maternal-Fetal Medicine Fellow in the Department of Obstetrics and Gynecology, University of California, Los Angeles


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