Blog 12

Today at Family Medicine Associates, Dr. LaBarge informed me that the two medical students from Tufts would not be completing their internship with us, and that they would be transferring to some other area. This was kind of a let down for me, as my learning was somewhat amplified in the presence of the medical students. As I explained in my earlier blogs, the two medical students asked a lot of in-depth questions that really intrigued me. After Dr. LaBarge broke the news to me, we continued seeing patients. We had one man in his sixties who had just returned from a six-month trip to the Caribbean and was due to head over to Findland soon. Unfortunately, his health was in horrendous condition, and Dr. LaBarge and I tried to get to the bottom of it. After some questioning and running some tests, we realized that he had high blood pressure and high cholesterol, which were both caused by his continued consumption of large portions of alcohol. This man claimed that he used to own a brewery, and that he would drink beer nonstop all day years ago. He currently still drinks heavily, and this seems to be the cause of his problems. Dr. LaBarge shared with me that a hefty percentage of the patients who come into the office have problems that are largely caused by their high levels of alcohol consumption. If people learn to drink alcohol in moderation, their health would be a lot easier to control, and he would see a lot less patients.

Blog 11

During my experience at SCORE and at Family Medicine Associates, I have come to the conclusion that when I become a physician, I do not wish to practice in primary care. After shadowing Dr. LaBarge for several weeks, I feel as though when I am right out of medical school that I will want to have something a little more fast-paced and exciting, such as working in the emergency room, or in the intensive care unit. There are interesting aspects to primary care, however, I just feel as though I am more interested in other areas of the field of medicine. For example, I did think that identifying and diagnosing diseases, illnesses, and conditions in patients was an awesome process. When I was shadowing Dr. LaBarge, we would listen to the symptoms of each patient, and from my education through Anatomy and Physiology, Psychology, and Biology, I was able to identify some ailments in patients, and sometimes, Dr. LaBarge would even ask me for a diagnosis before he gave the official one. I find that process intriguing, however, I feel as though I will see more interesting, and a wider variety of cases elsewhere in the field of medicine. One of the cool aspects of this field is that there is so many options, and once one obtains his or her M.D., that person can choose to practice in whatever area they please, given that they have the required training to do so. For now, I am ruling primary care out of my career interests, at least for the start of my career.

Blog 10

Up until the third week of my internship at Family Medicine Associates, I had run into very little issues. However, this week, I ran into something I had not put a whole lot of thought into. After seeing several patients, I went into a new room for the next patient, and realized that it was someone I knew personally, and someone who I had gone to school with. I cannot and will not reveal the name of said patient, however, I was very surprised and had not anticipated running into anyone who I knew personally. This patient was not too bad, as I just watched the doctor examine an ear infection, but my episodes of encountering familiar faces were far from over. From that point on, whenever a patient came up who was around my age, Dr. LaBarge would ask me if I knew said patient before observing, which saved me from several awkward situations. Yet, things were somewhat trickier with adults who I knew, simply due to the fact that Dr. LaBarge would not read off every name of every patient we would see. I have come to the conclusion that if I somehow make it and become a physician, I do not wish to work in this immediate area, simply due to the fact that I would see too many people who I have known for quite some time. Being a physician seems like it will be an extremely rewarding career, but I wish to avoid the awkwardness of working with people I know if possible.

Blog 9

One of the huge components of practicing medicine is upholding patient confidentiality. Basically, what this means is that patients’ medical records must be protected, and they have a right to privacy when being treated. What this means for me is that each and every single patient has the power over whether or not I have access to view their appointments. Each patient can surrender their privacy and allow me to observe, and they can also choose to have it be just the patient and the nurse/doctor. Physicals are off-limits to me because I am not medically qualified to conduct them, and they are usually very personal so patients wouldn’t want others observing anyways. When it comes down to it, this basically means that I cannot observe at least one third of all appointments, if not more, that are conducted by Dr. LaBarge. Thankfully, physicals are generally very repetitive, so I am not missing out on too much with regards to that type of appointment. But every now and then, I miss out on something interesting because the patient wishes to have privacy with the doctor. Now, this is completely necessary in the field of medicine, however, to me, it deprives me of opportunities. Another legal issue is filling out paperwork after each appointment. The doctor must fill out information regarding medications, appointments, etc. in order to make sure that they do not get sued for misinformation or malpractice or something along those lines. I had no idea how many legal concerns there were for something as simple as a check-up.

Blog 8

Dr. Labarge had informed me last week that we would be joined by two medical students from Tufts. I was excited to have more people join our squad. I came into the office and saw that there were two sets of bags and notebooks, so I came to the conclusion that they were already here. After waiting for a couple of minutes, Dr. Labarge, accompanied by the two students, came into the office. We shook hands and introduced ourselves, and made some small talk. They both seemed to love med school, which was pretty reassuring. However, after visiting several patients and after Dr. Labarge asked them questions regarding each patient’s condition, they were frequently incorrect with their diagnosis. Of course they knew a ton of vocabulary and terminology, however, they were slightly off on several occasions. I learned more than I would have that day because these students unleashed a barrage of questions on Dr. Labarge, some of which I couldn’t understand at all. I did my best to soak in all of the new information being rapidly released at me, but it was difficult. We went to view some X-rays afterwards, and discussed possible ailments that each patient was suffering from. One woman had pneumonia while another patient had a minor fracture of the clavicle. Dr. Labarge showed us how to view X-rays, and explained that it is best to start from the perimeter and work your way inwards. However, I only had SCORE for two hours that day, so my time with the medical students was limited as they would only be coming in on Mondays.

Blog 7

Today at SCORE I would be learning about something very common in primary care when dealing with children and certain adults: faking an illness. I came into the office at three o’ clock, my usual time, and went through some logistics with Dr. Labarge. After seeing a couple of patients, we went in to see a girl who had been in and out of the office several times over the past couple of months, all for the same reasons. She complained of drowsiness and a sore throat. Dr. Labarge gave some examinations of the girl, and we tested her for strep and other ailments. However, once again, everything came back negative. Not only was the girl convinced there was something wrong with her, but so were her parents, which made things even more difficult. Dr. Labarge had to communicate with both the patient and her parents for several minutes, assuring question after question while the patients demanded more and more information. The only thing Dr. Labarge could do was report the results of the test and attempt to assure them that nothing was wrong with their child. Apparently, this is somewhat of a common occurrence, as people are constantly trying to get out of commitments. In this case, the little girl obviously did not want to attend school the following day. Afterwards, we met with several other patients and didn’t find anything too out of the ordinary. Prescribing medication is a huge aspect of the job, and requires a ton of knowledge.

Blog 6

Today I came into Dr. Labarge’s office and sat down in my chair while I waited for him to return from seeing a patient. When he returned, he took me through his schedule for the day. Aside from a couple of physicals and some routine checkups, he told me that we would be seeing a little girl who’s mother had some concerns. Dr. Lararge informed me that this was fairly common, as mothers typically worry about their child and his/her development. Dr. Labarge entered first just to double check with the mother that it was alright if I observed as is standard procedure, and after I got the OK I went in. Dr. Labarge began with the typical evaluations, and asked the child some humorous questions to put her in a good mood. Afterwards, Dr. Labarge asked the patient to stand up and look at a light in the ceiling. He called me over and told me to look at the spot of light that was reflected in her eyes and asked me if there was a difference in size. It seemed as though there was a slight difference, and he explained that this could mean that the patient will develop poor eyesight. Next, we had the mother complete a questionnaire that basically evaluates if there is concern to whether or not the child may have autism. I found this pretty interesting, as it was just a simple survey asking about the child’s general activities, and based on the answers, it is decently accurate.

Week 2 Blog 5

Today started off as a normal day. I came in at my usual time of three o’ clock and made my way over to Dr. Labarge’s office. Sometimes when I come in, he is seeing a patient, and I have to wait in his office until he is done with said patient. We conducted some check ups, and he completed a couple of physicals, which I am not allowed to participate in, once again due to legal issues. However, for our last patient of the day, we were scheduled to see a 90 year old male with a heart condition. Dr. Labarge and I went into the room and greeted the patient etc. Dr. Labarge then proceeded to evaluate said patient by measuring his pulse and blood pressure. He noticed that the patient’s heart was racing, and upon further evaluation, it was determined that his heart was beating at around 160 times per minute, which is around three times as fast as it should be. Dr. Labarge expressed his concern, and ordered an EKG for the patient. I observed the EKG, as the nurse hooked up the machine and conduct the evaluation. Dr. Labarge and I waited for the results, and several minutes later we were able to observe them. Dr. Labarge came to the conclusion that this patient was suffering from an atrial flutter, meaning that the top sections of his heart were beating rapidly yet not pushing enough blood through. As a precaution, he was sent to the Emergency Room at Beverly Hospital to make sure that nothing serious transpired. It was a hectic end to my day.

Week 2 Blog 4

Dr. Labarge explained some of the logistics regarding scheduling to me today. Basically, he has a set schedule every day, and sees his patients accordingly. However, sometimes patients cancel due to a wide variety of reasons, or sometimes they simply do not show up. In this case, Dr. Labarge is free for however long he was scheduled to see that patient, during which he usually completes paperwork and fills out forms. The drawback is that it leaves me hanging out in his office with nothing to do because there are no patients to see. Fortunately, my advisor is accustomed to this kind of situation, and he schedules other tasks for me to do on occasion when this scenario arises. For example, if we are not seeing patients for an extended period of time, Dr. Labarge will send me off with one of the nurse practitioners to view their work. What this entails is observing the nurse take a brief evaluation of the patient. They ask a few questions regarding if the patient has any major concerns, and they usually take blood pressure and measure the patient’s heart rate. As I previously wrote, two of the nurses demonstrated to me how to measure a patient’s blood pressure (not on a real patient, just on another nurse due to legal issues), as well as other tasks such as taking an EKG of a patient, which measures the heart’s activity. In general, not having patients to see is a negative thing, however, it occasionally opens up new learning opportunities.

Week 1 Post 3 Matt Baker

On Thursday, I came into Family Medicine Associates at 3:00 once again. This time, Doctor LaBarge was waiting in his office for me, and he went over some briefing with me. He explained the symptoms of a condition called “Trench Foot,” which is basically improper healing of the foot. Soldiers back in World War I and II would get this condition often because it starts with the dampening of the feet. The soldier’s boots would then trap in this moisture and give it the “raisin effect” that people often experience when they’ve been in a swimming pool too long. The skin dies, and more and more layers of skin and puss form underneath, creating a callus that can be several inches thick, surrounding the entire foot. Afterwards, bacteria and other infections begin to run their course, and it is at this point where the disease reaches its peak of nastiness. He told me that we would be seeing someone with Trench Foot at some point over the next couple of days, which should be interesting. Afterwards, I was taken by a nurse to witness the application and usage of an EKG test, which measures voltage from the heart at various points throughout the body, to make sure that the patient has proper circulation and heart function. Everything with this particular patient turned out to be alright after a brief examination of the results. The doctor and I met with several other patients and by then my time for the day was up and I was ready to head home. 

Week 1 Post 2 Matt Baker

I showed up for my second day of SCORE at 3:00, which will be the standard time until AP classes are finished. Once again, I had to wait for a brief period of time for Doctor LaBarge to finish up seeing a patient. Today, I was taken through many of the procedures that a doctor has to participate in after the patient leaves. There is a lot of behind the scenes legal issues that have to be tended to. After seeing each patient, Dr. LaBarge sits at his desk and fills out information on his laptop for formalities, and, if something were to go wrong, so that lawyers have information to go off of. Most of it seemed pretty easy, as Dr. LaBarge made several clicks on a form and was done. However, it does seem tedious, as he has to fill out information forms after each and every patient. During the second half of my day, a nurse swung by the office and took me away to practice measuring blood pressure. I went off to a separate room where another nurse was waiting, and the two demonstrated how to measure and read a patient’s blood pressure (one played a nurse while the other played a patient). There were several things I had to keep in mind, such as keeping a slow and steady release of pressure after cutting off circulation, but it seemed fairly easy. To finish off the day, the doctor and I met with a couple more patients with fairly common ailments such as a sore throat, a cough, etc. 

Week 1 Post 1 Matt Baker

For my first day at SCORE, I came into Family Medicine Associates not knowing what to expect. I was met at the front desk by the receptionist and directed towards the office of Dr. Harlow LaBarge. I sat down in a chair and waited for him for a couple of minutes (he was with a patient) and met him soon after. He then took me through some of the basics regarding what we would be doing for a daily routine. He recommended that I wear a nice shirt, khakis (or dress pants), and nice shoes each day, in order to maintain a professional image. He also informed me that the two of us would be seeing a variety of patients each day for the vast majority of my time spent at the internship. However, I would not be allowed to see some of the patients due to legal reasons. For example, physicals are largely off limits, simply to protect the privacy of each patient. For my first day, I was able to see several patients with varying ailments. The first patient was an elderly woman who was getting an x-ray on her chest cavity, because previous doctors had noticed a small blotch on one of her lungs. Upon further examination by myself and the doctor, we came to the conclusion that it was nothing serious and broke the good news to the woman. Dr. LaBarge took me through the steps of reviewing an x-ray, and pointed out various parts important landmarks. I had an insightful first day, and am looking forward to the variety of encounters I will have in the future. 

MBaker's Outline

Matt Baker

2/13/13

S.C.O.R.E. Thesis & Outline

Project: Shadowing a Primary Care Physician

Thesis:

            Private insurance companies have negative impacts on our health insurance system in that they fail to provide proper and sufficient coverage, they cater to the wealthy and abuse the poor by providing coverage based on how much you can pay, and the costs of private medical insurance is rising at a higher rate than inflation.  

Outline:

Introduction

·      Defining our health care system

·      Thesis

Idea 1 – Compare U.S. health care system to others

·      We spend the most on health care

·      We do not provide the most coverage

·      We do not insure the largest percentage of citizens

Idea 2 – Lack of coverage

·      Compare private to public coverage

Idea 3 – Benefit rich, abuse poor

·      Only rich are able to afford adequate health care

Idea 4 – Rising costs

·      Health care companies overcharge with respect to coverage they provide

·      Rising faster than inflation rate

Conclusion

·      Summary of main ideas

Works Cited

Brawley, Otis Webb., and Paul Goldberg. How We Do Harm: A Doctor Breaks Ranks about Being Sick in America. New York: St. Martin's, 2012. Print.

Brill, Steven. "Bitter Pill." Time Magazine 4 Mar. 2013: 16-55. Web.

Brownlee, Shannon. Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer. New York, NY: Bloomsbury, 2007. Print.

Garrett, Laurie. Betrayal of Trust: The Collapse of Global Public Health. New York: Hyperion, 2000. Print.

"Health Care Statistics | Health Care Problems." Health Care Problems RSS. N.p., n.d. Web. 13 Mar. 2013.

Long, Robert Emmet. The Crisis in Health Care. New York: H.W. Wilson, 1991. Print.

Nather, David. The New Health Care System: Everything You Need to Know. New York, NY: Thomas Dunne, 2010. Print.

"US Health Care: It's Officially a Mess, Institute Says." NBC News. N.p., n.d. Web. 13 Mar. 2013.

"The US Healthcare System 2010." The US Healthcare System 2010. N.p., n.d. Web. 13 Mar. 2013.

Weil, Andrew. Why Our Health Matters: A Vision of Medicine That Can Transform Our Future. New York: Hudson Street, 2009. Print.

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