We thought that as we come to the end of our second day at the clinic we should update you all on how we’re getting on!
The clinic that we are attached to for the next month is situated in a small area called Big Sky, just north of Yellowstone National Park. The area is spectacularly beautiful, and the patients that we get are both locals and tourists. We get a mix of presenting complaints – from repeat prescriptions, right up to acute fractures and lacerations.
We definitely felt launched in at the deep end yesterday morning- our month of not being allowed within two feet of actual real life patients in Boston seems to have erased most medical knowledge from our brains!
The clinic doesn’t open until 10am – it’s such a luxury to be able to wake naturally at 8am and still have time for a leisurely breakfast! The 5am alarms seem all but a distant memory, thank goodness!
The first half hour of clinic is usually pretty frantic – the blood courier comes at 10.30am to take the samples off to Bozeman (the nearest hospital). So we start the day taking bloods and centrifuging the samples (something Helen found very exciting!…simple things!)
In theory, the clinic works in a similar way to GP practices in the UK, but with some key, bizarre, differences! With each patient we go into a clinic room individually and take their history and examine, before grabbing Dr Daniels to go back in with us to discuss what’s actually going on. One of the big differences that we have noticed is that all the medications have totally different names here. We have both felt slightly idiotic having to ask patients to spell out their drug names for us, and more importantly what they use them for! Hopefully with time we’ll pick up a few of these. Also, the patients get given drugs for EVERYTHING! There have been several patients over the last couple of days that we have felt pretty certain just have viral colds, but they leave the clinic with a prescription for opioid cough syrup, a steroid injection and some fairly strong asthma medication!
We have also been trying to muddle our way through the US insurance system- all the consultations are billed, and therefore everything has to be coded appropriately so that the insurers know exactly what the patient can claim for. It’s so foreign to the NHS system, neither of us can quite get our heads round it.
While we are seeing a patient we take paper notes, and make sure we record all of their vitals (oxygen, BP etc), which is very important for billing. It has been nice to get back into doing these simple tasks! Once we have finished the consultation and the patient has been diagnosed and treated (they are always treated!) we use a very snazzy MacBook programme to electronically update the patient records. Currently, this is something we are both finding way more enjoyable than it should be!!
The clinic itself is pretty swish – the patient waiting room looks like something you’d find in an upmarket hotel lobby, complete with rustic sofas and rugs! The staff – one doctor, one technician and two secretaries are very friendly, and there are always fresh cookies or bagels waiting for us on our arrival in the morning!
The clinic has three consulting rooms, but is also equipped with it’s own X-Ray room and the very friendly technician, Brad, has been great at showing us the ropes. Having an X-Ray machine allows fractures to be picked up right here in clinic. So, if anyone comes in with a displaced fracture the doctor/student should be able to manipulate it straight away before putting the patient in a cast! It’s pretty cool how many procedures they do out here – being so rural they don’t really have a choice! We should get the chance to do all of these things soon, which is pretty exciting!!
Overall we’re having great fun, and walking out the door at the end of the day to see Lone Peak towering up above us is pretty breathtaking.
Tonight we’re off to a restaurant called The Corral with Sam and Scott. We’ve been promised it’s a true Montana experience!
We obviously still haven’t fully adjusted to altitude! Maybe we could blame any gaps in our knowledge on a lack of oxygen??
An American Elective 